The oral pathogen Aggregatibacter actinomycetemcomitans (Aa) links periodontal disease and rheumatoid arthritis (RA) by generating citrullinated autoantigens. The figure shows periodontal disease on the right and a rheumatoid joint on the left. The periodontal pathogen Aa (shown in the magnification) drives the production of citrullinated proteins, which initiate an antibody response. Anti-citrullinated protein antibodies (ACPAs) and citrullinated antigens spark the immune system, driving the cascade of events leading to RA.
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