Early Antibiotic Use Increases JIA Risk Save

A population based Swedish study of birth records shows that antibiotic exposure in first three years of life to be associated with a future risk of juvenile idiopathic arthritis (JIA), although infections during fetal life or childhood did not increase risk of JIA.

Data drawn from ABIS (All Babies in Southeast Sweden), a population-based prospective birth cohort of 17,055 children, included information on infections and antibiotic exposure during pregnancy and childhood. From this cohort, 102 individuals with JIA were identified.

At multiple time frames, exposure to antibiotics was significantly associated with increased JIA risk. Those exposed to antibiotics during the first 3 years of life (vs. unexposed) had a 3 fold future risk of JIA (aOR 3.17; 95% CI 1.11–9.03, p = 0.031). This augmented risk persisted out to 8y ears were there was still a JIA were 78% higher odds of developin JIA (aOR 1.78; 95% CI 1.15–2.73, p = 0.009). Interesting caveats:

• Antibotic exposure during pregnancy was only associated with a higher risk of systemic JIA (aOR 5.26; 95% CI 1.18–23.51, p = 0.030).
• Oligoarticular JIA showed significantly higher use of penicillins in the 5–8 years age group (aOR 1.44; 95% CI 1.03–2.02, p = 0.034)

• Rheumatoid-factor-negative polyarthritis tended toward higher antibiotic consumption during the first year of life (aOR 1.52; 95% CI 0.96–2.41, p = 0.073) and higher non-penicillins use at 1–3 years (aOR 1.83; 95% CI 1.04–3.21, p = 0.036) and 5–8 years (aOR 7.59; 95% CI 1.38–41.63, p = 0.006). 

• Enthesitis-related arthritis was associated with antibiotics in the first year of life (aOR 1.87; 95% CI 1.06–3.28, p = 0.029) and at 5–8 years of age (aOR 1.52; 95% CI 1.10–2.09, p = 0.011), for both penicillin and non-penicillins. 

Amongst antibiotics, penicillins were more frequently used than non-penicillins, but both had an equal effect on the risk of developing JIA.  Interestingly, infections during fetal life or childhood showed no significant association with the risk of developing JIA, after confounder adjustment.

These data mirror that previously reported in a UK cohort, where a nested case-controlled retrospective analysis found a 2 fold increased risk of developing JIA compared to children the same age who were not prescribed antibiotics (adjusted odds ratio 2.1 [95% confidence interval: 1.2–3.5]).

The mechanistic role of antibiotics in causing JIA is unclear but could be related to microbiome changes or maturational (mucosal) immune changes lending to future autoimmune disease.