Investigators Call for More Research on Juvenile Arthritis and Exposure to Maternal Infection

Anna Sutton, MPH

Investigators have wondered if maternal infection had any influence on childhood autoimmune disorders like type I diabetes. However, due to the lack of substantial literature around juvenile idiopathic arthritis (JIA), Anna Sutton, MPH, Department of Epidemiology, University of Washington School of Public Health, decided to lead an investigation on the association between JIA and maternal infection.

The results didn't show that children who were exposed to maternal infection had an increased risk of juvenile idiopathic arthritis. Although, investigators stated that there was suggestive evidence of differential sex-specific results that should be studied further.

Results Show Need for Further Research

While the outcomes of this case-controlled study didn't indicate a significant association for the primary relationship in question, in the sex-stratified analysis, data suggested the potential that juvenile idiopathic arthritis has an increased correlation with females who have been exposed to maternal infection.

"In our primary analysis, there was no significant difference in the odds of being diagnosed with JIA based on maternal infection exposure (OR = 1.02, 95%CI: 0.78 - 1.34)," investigators stated. "When stratified by infant sex, the odds of being diagnosed with JIA were higher for females (OR = 1.12, 95%CI: 0.79 - 1.57) than males (OR = 0.85, 95%CI: 0.53 - 1.37), but this result was not statistically significant (interaction p = 0.39)."

When looking at specific categories of the juvenile condition, RF-negative polyarticular JIA, persistent oligoarticular JIA, and enthesitis-related arthritis were the only subsets with enough data to be analyzed. There were no statistically significant increseases or decreases in the odds ratios of these categories.

Reviewing the Data

In the study, as in the general disease population, more than half (68%) of JIA cases were represented in females. Cases of children who were under the age of 20 years old with JIA between 1997-2010 were utilized. Investigators used logistic regression to calculate adjust odds ratios and 95% confidence intervals.

With data obtained from a tertiary care hospital database in Washington state, 1290 JIA cases were included and 6072 control cases were matched on the birth year. Washington state birth records from 1980-2006 were used to collect information regarding maternal infection.

"This study is an initial exploration of fetal response to infection as a mechanism for JIA," investigators wrote. "While we did not find an overall association between JIA and maternal infection, our results suggest that future studies focused on the individual categories of JIA and gender related differences should be considered."

The study, "Association of juvenile idiopathic arthritis with maternal infection: a case control study" was published in Pediatric Rheumatology.