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Antibiotic Use May Increase Child's Risk of Developing Juvenile Arthritis

Jul 28, 2015

A study published last week in Pediatrics finds that taking antibiotics may increase a child's risk of developing juvenile arthritis.

Researchers from Rutgers University, University of Pennsylvania, and Nemours A.I. duPont Hospital for Children found that children who were prescribed antibiotics had twice the risk of developing juvenile arthritis compared with children who did not receive antibiotics, MedicalXpress reports. The more courses of antibiotics prescribed, the higher the risk, they researchers found, and the risk was greatest within one year of taking antibiotics.

The Centers for Disease Control and Prevention (CDC) says that between 4,300 and 9,700 children under the age of 16 are diagnosed with juvenile arthritis each year. Juvenile arthritis is an autoimmune disease that involves chronic inflammation of the joints and eyes. The disease can cause pain, vision loss, and disability. Genetics can explain about one quarter of the cases of juvenile arthritis, which means that environmental triggers may also play a role in the onset of the disease, according to MedicalXpress.

Research studies have indicated that about a quarter of antibiotics prescribed for children—including half those prescribed for acute respiratory infections—are probably not necessary. Dr. Daniel Horton, a postdoctoral research fellow in the Department of Pediatrics at Rutgers Robert Wood Johnson Medical School, says the arthritis findings are "another possible reason to avoid antibiotic overuse for infections that would otherwise get better on their own." Horton is lead author of the study.

The research team began their study in 2014 because other studies had shown that antibiotic use could predispose children to developing chronic diseases such as inflammatory bowel disease, MedicalXpress reports. Disruption of microbial communities in the intestines and elsewhere appears to play a role in inflammatory bowel disease and other autoimmune diseases, including rheumatoid arthritis in adults. "Antibiotics are one of the better known disruptors of human microbial communities," Horton explains.

The researchers used the Health Improvement Network (THIN) database that has information on more than 11 million people in the United Kingdom. The researchers compared children with newly diagnosed juvenile arthritis with age- and gender-matched control subjects. Of about 450,000 children studied, 152 were diagnosed with juvenile arthritis. After adjusting for other autoimmune conditions and previous infection, children who received antibiotics had an increased risk for developing the disease, according to MedicalXpress. The researchers also found that upper respiratory tract infections treated with antibiotics were more strongly associated with juvenile arthritis than untreated upper respiratory tract infections. Antiviral and antifungal drugs were not linked to juvenile arthritis, suggesting that risk for arthritis was specific to antibacterial medications.

Viral infections have been suggested as triggers for juvenile arthritis, but a number of studies argue against this hypothesis, according to MedicalXpress. But Horton says that children with juvenile arthritis have a higher risk of serious infections, in part because their immune systems do not protect them against infections as well as they should. Horton says an "alternative explanation” the findings is that the abnormal immune system makes children more susceptible to serious infection even before they are diagnosed with arthritis. "[A]ntibiotics would be a marker for abnormal immunity rather than a direct cause of arthritis." Most children get antibiotics but since only about one in a thousand develops arthritis, antibiotics are not the only factor in the development of the disease, Horton said, and further research is needed to understand the mechanism that might link antibiotic use and juvenile arthritis.

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