Antibiotic use Increases Risk of Rheumatoid Arthritis in Kids

http://www.medpagetoday.com/MeetingCoverage/ACR/48682

ACR: A Role for the Microbiome for Arthritis in Kids?

Published: Nov 18, 2014 | Updated: Nov 18, 2014

By Nancy Walsh, Senior Staff Writer, MedPage Today
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Study Author: Daniel Horton, MD
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BOSTON -- Children who were exposed to Antibiotics had an increased risk of developing juvenile idiopathic Arthritis (JIA), a researcher reported here.

After adjusting for potential confounders, any Antibiotic use was associated with more than twice the risk of JIA (OR 2.6, 95% CI 1.5-4.6), according to Daniel B. Horton, MD, of the University of Pennsylvania in Philadelphia.

"Dysregulation of the human microbiome has been implicated in the development of several autoimmune diseases, including Rheumatoid Arthritis and inflammatory bowel disease, and exposure to Antibiotics has been linked with inflammatory bowel disease in children," Horton said in a presentation at the annual meeting of the American College of Rheumatology.

To see if early exposure to Antibiotics could influence risk for JIA, he and his colleagues conducted a nested case-control study using the U.K. Health Improvement Network, which is a population based database that includes extensive diagnostic and outpatient prescription drug information.

Children who had been diagnosed with JIA before age 16 were identified and each was matched according to age and sex with 10 controls.

Exclusion criteria included a history of inflammatory bowel disease, autoimmune connective tissue disease, vasculitis, or immunodeficiency.

A total of 153 children with JIA were included, along with 1,530 controls.

The risk of JIA increased in a dose-dependent manner, with the number of prescriptions:

one to two courses, OR 2 (95% CI 1.1-3.7, P=0.03)
three to five courses, OR 3.1 (95% CI 1.6-5.8, P<0.001)
More than five courses, OR 3.8 (95% CI 1.9-7.3, P<0.001)
The relationship between antibiotics and incident JIA remained after adjustment for the number and types of infections and for the different classes of antibiotics, although antifungal and antiviral agents didn't appear to be associated.

"This study implicates a role for Antibiotic exposure in disease pathogenesis, perhaps mediated through alteration in the microbiome," he concluded.

However, other possible explanations could be that children who develop JIA have a greater risk of infection early in life warranting the use of antibiotics, or that infections themselves play a role in the disease pathogenesis and antibiotics are simply a marker, he said at a press conference.

"But if it turns out that antibiotics do play a role, this could be a modifiable risk factor for the prevention of JIA, in that one-quarter of antibiotics for children in the outpatient setting are for respiratory infections and don't need antibiotics," he told MedPage Today.
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