July 29, 2015
Does Antibiotic Use Increase Risk of Juvenile Arthritis?

New Brunswick, NJ—The risk of promoting antibiotic resistance is one good reason to limit overuse of the drugs. Another, according to a new study, is that prescribing antibiotics unnecessarily could increase the risk of juvenile arthritis in children.

The study, published recently in the journal Pediatrics, found that children prescribed antibiotics doubled their risk of developing juvenile idiopathic arthritis (JIA) compared to similar children who did not take the drugs.

Furthermore, the risk increases with additional courses of antibiotics prescribed, according to researchers from Rutgers The State University of New Jersey in New Brunswick; the University of Pennsylvania in Philadelphia, and Nemours A.I. duPont Hospital for Children in Wilmington, DE. Study authors add that the risk was strongest within 1 year of receiving antibiotics.

“Antibiotics were associate with newly diagnosed JIA in a dose- and time-dependent fashion in a large pediatric population,” the authors write. “Antibiotic exposure may play a role in JIA pathogenesis, perhaps mediated through alterations in the microbiome."

Between 4,300 and 9,700 children younger than 16 are diagnosed annually with juvenile arthritis, a form of autoimmune disease involving chronic inflammation of the joints and eyes, according to background information in the article.

The report also cites previous studies indicating that about half of all antibiotics prescribed for acute respiratory infections—and about one-fourth of antibiotics prescribed to children overall—are likely to have been unnecessary.

“Our research suggests another possible reason to avoid antibiotic overuse for infections that would otherwise get better on their own,” said lead author and postdoctoral research fellow Daniel Horton, MD, in a Rutgers news release.

The impetus for the new study was previous research indicating that antibiotics could predispose children to inflammatory bowel disease and other chronic conditions, possibly because of disruption of microbial communities in the intestines and elsewhere.

“Antibiotics are one of the better known disruptors of human microbial communities,” Horton noted. Employing the Health Improvement Network (THIN), which includes data on more than 11 million United Kingdom patients cared for by general practitioners, researchers compared children with newly diagnosed juvenile arthritis with age- and gender-matched control subjects.

With 152 of the about 450,000 children studied diagnosed with juvenile arthritis, the study found a link between antibiotic prescription and the risk of developing the disease.

Interestingly, upper respiratory tract infections treated with antibiotics were more strongly associated with juvenile arthritis than untreated upper respiratory tract infections, the researchers report. Because antiviral and antifungal drugs were not linked to juvenile arthritis, they posit that the risk for arthritis was specific to antibacterial therapy.

“This is an extremely important clue about the etiology of this serious and potentially crippling disease. If confirmed, it also provides a means for preventing it,” said senior author Brian Strom, MD, MPH, chancellor of Rutgers Biomedical and Health Sciences.

An alternative explanation, according to Horton, is that abnormal immune systems make “children more susceptible to serious infection even before they are diagnosed with arthritis. 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 1 in 1,000 gets arthritis,” he added. “So even if antibiotics do contribute to the development of arthritis, it’s clearly not the only factor.” He urged further research to conform the study’s findings.

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