Antibiotics in Children are increasing risks of Juvenile Arthritis

Systemic-Onset-Juvenile-Idiopathic-Arthritis

Juvenile Rheumatoid Arthritis(JRA): also known as Juvenile Idiopathic Arthritis (JIA) is a condition occuring in children before the age of 16 and is characterized by inflammation of joints which causes pain, stiffness and swelling. Rash, fever and eye inflammation can also be caused by JIA. The disease is said to be chronic if symptoms are lasting for 6 weeks or more.

According to the investigators reporting at the American College of Rheumatology 2014 annual meeting in Boston: exposure to antibiotics in early stages of life can significantly increase the chances for juvenile Idiopathic arthritis in a dose dependent manner.

It was suggested that due to certain changes and variations in the human microbiome, patients faces or develops certain diseases. 

Microbiota: the human microbiome constitutes of trillions of microorganisms,  present in our mouth, intestines,  skin etc and are involved in the regulation of metabolic and immune functions. Some bacteria have anti inflammatory action while some have pro inflammatory effects. If the nature of microbiota is changed to a level where pro inflammatory bacteria overwhelms, could lead to the development of arthritis and other autoimmune diseases. So, this means that  dysregulation of microbiota can be involved in the development of autoimmune diseases.

Daniel Horton, MD from University of Pennsylvania in Philadelphia said ” the more we learn about the microbiome, the more it appears that it plays an important role in a variety of different diseases, such as autoimmune diseases, IBD & rheumatoid arthritis & perhaps psoriatic arthritis – all of which have some common features with juvenile arthritis. 

Previous studies have also shown that antibiotic use in childhood is linked to the inflammatory bowel disease development.

Study: using a UK population based database of medical records, the investigators found out that 153 children were diagnosed with JIA before the age of 16. A total of 153 children with JIA were included  with 1530 controls. It was seen that the risk of JIA increased in a dose dependent manner, with the increasing number of prescriptions;

a. 1-2 courses, OR 2 (95% cl 1.1-3.7, P=0.03)

b. 3-5 courses, OR 3.1 ( 95% cl 1.6-5.8, P < 0.001)

c. more than 5 courses, OR 3.8 ( 95% cl 1.9-7.3, P < 0.001)

Results: showed that these children who were exposed to antibiotics (antibacterials only and not non bacterial antimicrobial agents I.e. antivirals and antifungals) were at very high risks of JIA as compared to those children who were not exposed to the antibiotics. And JIA risk was seen to be strongest with children exposed to multiple courses of antibiotics. 

Antibiotics are definitely necessary for treating some infections but these drugs are also over prescribed for other infections especially respiratory, that will usually resolve without treatment. (Dr.Horton)

Other reasons for JIA: other possible explanations include child developing JIA is at a greater risk of infections early in life which requires antibiotics. 

Infections themselves could also be playing a role in the disease development. 

Conclusion: If a link between juvenile rheumatoid arthritis and antibiotics is ascertained, then the antibiotic avoidance when suitable in right clinical situations can prove very helpful in preventing such life threatening diseases.

Reference:

1. American College of Rheumatology News Release.

2. Web MD

3. Mayo clinic.

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