December 9, 2022

Early exposure to antibiotics linked to juvenile idiopathic arthritis


Although dose-dependent, there is an association between early exposure to antibiotics and later juvenile idiopathic arthritis, according to a study published in Pediatric rheumatology.1

“The genetic components are only a small part (10-25%) of the cause, and unknown environmental factors are considered to be the main cause of the disease,” investigators said. “Environmental factors such as viral infections have been suggested, but other studies have not been able to confirm these results.”

Parents of children born between October 1, 1997 and October 1, 1999 received a survey from All Babies in Southeast Sweden (ABIS) designed to collect data on infections and antibiotic use during pregnancy and childbirth. childhood. A total of 17,055 (78.6%) families agreed to participate in the prospective population-based study, of which 102 children were diagnosed with JIA according to an International Classification of Diseases (ICD) code during of the 19-year follow-up period.

In addition to blood samples taken at birth and at 1, 3, 5 and 8 years, parents were periodically asked about nutrition, drug use, vaccinations and infections. Adjusted logistic regression analyzes for all confounding factors.

The majority of JIA cases were female (68%) and the median age at diagnosis was 12 years. Most JIAs were classified as oligoarthritis and polyarthritis.

The results indicated that antibiotic exposure for 1 to 12 months, 1 to 3 years, and 5 to 8 years was linked to an increased risk of developing JIA. In addition, JIA was 3 times more common in patients who were exposed to antibiotics in the first 3 years of life compared to controls (aOR 3.17; 95% CI 1.11 to 9.03, p = 0.031) and twice as high for those who received antibiotics in the first 5 years of life (aOR 2.18; 95% CI 1.36–3.50, p = 0.001). The risks of developing JIA were 78% higher for patients who received antibiotics in the first 8 years of life compared to controls (aOR 1.78; 95% CI 1.15–2.73, p = 0.009).

The number of courses of antibiotics was significantly higher in patients later diagnosed with JIA (p

Infection in the first year of life was seen in more JIA patients compared to controls (39% vs. 26%, respectively). However, after adjustment, the association was no longer significant.

Antibiotic use during pregnancy has been linked to systemic juvenile idiopathic arthritis (sJIA) and oligoarticular JIA has been observed more often in patients who received a higher number of doses of penicillin between 5 and 8 years.

The prospective nature of the study limits recall and selection bias and distributes any bias equally between JIA patients and controls. In addition, all JIA diagnoses have been validated through medical records and the Swedish Pediatric Rheumatology Register and the ABIS cohort is generally representative of the Swedish population. However, the small number of JIA patients and a large percentage of patients lost to follow-up limit the study.

“The results suggest a causal relationship between the use of antibiotics in particular and the development of JIA,” the investigators concluded. “Regardless of mediation mechanisms, these results suggest that restrictive antibiotic policies in the first years of life should be recommended. “


Kindgren E, Ludvigsson J. Infections and antibiotics during fetal life and childhood and their relationship to juvenile idiopathic arthritis: a prospective cohort study. Pediatr Rheumatol Online J. 2021; 19 (1): 145. Posted September 16, 2021 doi: 10.1186 / s12969-021-00611-4