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Understanding the role of these factors could inform strategies to mitigate both periodontal and synovial inflammation. This study aimed to investigate the prevalence of\n                    <jats:italic>P. gingivalis<\/jats:italic>\n                    virulence factors and their potential impact on disease activity in patients with periodontitis, rheumatoid arthritis (RA), or both conditions. Patients with RA (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200922), RA plus periodontitis (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200922), periodontitis (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200910), and healthy controls (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200935), were compared for C\u2010reactive protein levels, anti\u2010cyclic citrullinated peptide IgG, peptidylarginine\u2010deiminase (PAD)2\/4 activity and anti\u2010\n                    <jats:styled-content style=\"fixed-case\">\n                      <jats:italic>P. gingivalis<\/jats:italic>\n                    <\/jats:styled-content>\n                    virulence\u2010associated gingipain antibodies. All patients with periodontitis were compared for\n                    <jats:italic>P. gingivalis<\/jats:italic>\n                    ,\n                    <jats:styled-content style=\"fixed-case\">\n                      <jats:italic>Tannerella forsythia<\/jats:italic>\n                    <\/jats:styled-content>\n                    and\n                    <jats:styled-content style=\"fixed-case\">\n                      <jats:italic>Prevotella intermedia<\/jats:italic>\n                    <\/jats:styled-content>\n                    colony\u2010forming units, and gene variants of\n                    <jats:styled-content style=\"fixed-case\">\n                      <jats:italic>P. gingivalis<\/jats:italic>\n                    <\/jats:styled-content>\n                    , including PAD (\n                    <jats:italic>P<\/jats:italic>\n                    .PAD), major fimbriae (\n                    <jats:italic>fimA<\/jats:italic>\n                    ), lysine\u2010gingipain (\n                    <jats:italic>kgp<\/jats:italic>\n                    ), and receptor antigen gene B (\n                    <jats:italic>ragB<\/jats:italic>\n                    ). Higher mean clinical periodontal attachment loss was observed with\n                    <jats:italic>P<\/jats:italic>\n                    .PAD type 1 (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.033). The major fimbriae and lysine\u2010gingipain gene variants showed distinct distributions between groups. Anti\u2010gingipain IgG levels showed positive correlations with RA disease activity. Despite limitations, this study supports a role for\n                    <jats:italic>P. gingivalis<\/jats:italic>\n                    in exacerbating periodontitis and RA underscoring the importance of\n                    <jats:italic>P. gingivalis<\/jats:italic>\n                    virulence factors in disease modulation and highlighting potential therapeutic strategies. Further research is needed to elucidate mechanistic pathways and develop effective interventions.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Trial Registration:<\/jats:bold>\n                    ISRCTN 17950307;\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/doi.org\/10.1186\/ISRCTN17950307\">https:\/\/doi.org\/10.1186\/ISRCTN17950307<\/jats:ext-link>\n                  <\/jats:p>","DOI":"10.1111\/sji.70128","type":"journal-article","created":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T04:14:47Z","timestamp":1781324087000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Virulence Factors of\n                    <i>Porphyromonas gingivalis<\/i>\n                    in Periodontitis and Rheumatoid Arthritis: Clinical Implications"],"prefix":"10.1111","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5601-7974","authenticated-orcid":false,"given":"S. Silva","family":"Daniela","sequence":"first","affiliation":[{"name":"Periodontology Institute, Faculty of Medicine University of Coimbra  Coimbra Portugal"},{"name":"CIMAGO, Faculty of Medicine University of Coimbra  Coimbra Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8299-7603","authenticated-orcid":false,"given":"Kaminska","family":"Marta","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Broegelmann Research Laboratory University of Bergen Faculty of Medicine and Dentistry  Bergen Norway"},{"name":"Faculty of Biochemistry Biophysics and Biotechnology, Department of Microbiology Jagiellonian University  Krakow Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1023-9384","authenticated-orcid":false,"given":"Mizgalska","family":"Danuta","sequence":"additional","affiliation":[{"name":"Faculty of Biochemistry Biophysics and Biotechnology, Department of Microbiology Jagiellonian University  Krakow Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Potempa","family":"Jan","sequence":"additional","affiliation":[{"name":"Faculty of Biochemistry Biophysics and Biotechnology, Department of Microbiology Jagiellonian University  Krakow Poland"},{"name":"School of Dentistry, Department of Oral Immunity and Infectious Diseases University of Louisville  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"de Vries","family":"Charlotte","sequence":"additional","affiliation":[{"name":"Department of Medicine Solna, Division of Rheumatology Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7625-964X","authenticated-orcid":false,"given":"Lundberg","family":"Karin","sequence":"additional","affiliation":[{"name":"Department of Medicine Solna, Division of Rheumatology Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2782-6780","authenticated-orcid":false,"given":"P.","family":"da Silva Jos\u00e9 Ant\u00f3nio","sequence":"additional","affiliation":[{"name":"Rheumatology Department Centro Hospitalar e Universit\u00e1rio de Coimbra EPE  Coimbra Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine University of Coimbra  Coimbra Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4503-5365","authenticated-orcid":false,"given":"P. 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