Antibiotics May Increase Inflammatory Arthritis Risk Save
A Danish registry study has shown that amongst those patients who develop inflammatory arthritis (IA), antibiotics use was more frequent when compared to the background population (BP).
This isn't the first time this association between antibiotic usage and futher inflammatory arthritis has been claimed based on large cohort analyses. Previous reports on RheumNow have shown:
- Antibiotics were associated with a dose related risk of an RA diagnosis. Patients receiving >10 antibiotics in a 5 year period were twice as likely to receive an RA vs controls [adjusted odds ratio 2.65 (CI 2.40, 2.93)]
- Another UK Clinical Practice Research study showed a 60% increased risk of RA (OR 1.60; 95% CI 1.51–1.68) with antibiotic exposure.
- Swedish study showed that antibiotics during the first 3 years of life resulted in a 3 fold future risk of JIA (aOR 3.17; 95% CI 1.11–9.03, p = 0.031).
- UK study of the THIN network found a 2 fold increased risk of developing JIA with exposure to antibiotics (adjusted odds ratio 2.1 [95% confidence interval: 1.2–3.5]). The more courses of antibiotics prescribed, the higher the risk.
The current study identified adults with a first-time diagnosis of rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis/spondyloarthritis (AS/SpA) between 2010 and 2018. Each IA patient was randomly matched (sex, age) to ten persons from the BP.
From a total of 28 504 new-onset IA patients (RA, n = 16 130; PsA, n = 5,988; AS/SpA, n = 6,386; compared to 285 040 BP) they found that prior antibiotic dispensing was seen in 42.1% in IA patients before diagnosis vs 30.7% in the BP.
A higher rate of prior antibiotic dispensing found in the one-year before both the diagnosis of RA, PsA, and As/SpA (prevalence rate ratios [PRR], 1.48 [1.46; 1.51]; 1.67 [1.62; 1.72]; 1.52 [1.47; 1.56], respectively). Antibiotic dispensing in IA patients decreased in the year following the diagnosis.
Hence the question, why does antibiotic utilization associate with future development of IA and its subsets? Is it simply that sicker patients get more abnormal medical conditions or might antibiotic usage portend or predict unfavorable microbiome changes conducive to developing RA or autoimmunity.
ADD THE FIRST COMMENT
Disclosures
The author has no conflicts of interest to disclose related to this subject
If you are a health practitioner, you may Login/Register to comment.
Due to the nature of these comment forums, only health practitioners are allowed to comment at this time.