Juvenile Arthritis Risk Higher from Antibiotic Use

The risk for juvenile arthritis may increase due to exposure to antibiotics, according to a study published in the journal Pediatrics.

Researchers from Rutgers University observed a population representative sample of children in the United Kingdom in order to determine if antibiotic exposure was linked to newly diagnosed juvenile idiopathic arthritis (JIA). The children diagnosed with JIA were compared to age and gender matched control subjects pulled from general practices. Control matched children were excluded from the study if they had inflammatory bowel disease, immunodeficiency, or other systemic rheumatic diseases. The researchers began in 2014 after noting that antibiotics could predispose children to other chronic diseases because of disturbances in the microbial communities.

Of the nearly half million children involved in the analysis, 152 were diagnosed with JIA. The researchers found that after adjusting for factors like autoimmune conditions and previous infections, the children with prescriptions for antibiotics had an increased risk for developing JIA.

“This is an extremely important clue about the etiology of this serious and potentially crippling disease,” senior author Brian Strom explained in a press release. “If confirmed, it also provides a means for preventing it.”

The researchers additionally found that upper respiratory tract infections treated with antibiotics were strongly associated with JIA compared to untreated upper respiratory infections. The authors said the antiviral and antifungal drugs were not associated with JIA, which suggests that only antibacterial medications posed an increased risk for JIA.

“An alternative explanation to our findings is that this abnormal immune system makes children more susceptible to serious infection even before they are diagnosed with arthritis,” explained postdoctoral fellow Daniel Horton, lead author on the study. “Under this hypothesis, antibiotics would be a marker for abnormal immunity rather than a direct cause of arthritis. A majority of children get antibiotics, but only about one in 1,000 get arthritis. So even if antibiotics do contribute to the development of arthritis, it's clearly not the only factor.”

Some studies argue against this hypothesis, but most of the studies seem to concur that JIA patients have an increased risk for serious infections. Researchers hypothesize that this is due to their weakened immune system. Horton added that more research is required to confirm these findings in wider populations and to further understand the mechanism that triggers JIA through pediatric antibiotic use.