Disclosures: The researchers report no relevant financial disclosures.
October 14, 2021
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Antibiotics exposure in early life linked to juvenile idiopathic arthritis

Disclosures: The researchers report no relevant financial disclosures.
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Exposure to antibiotics in early life is associated with the later onset of juvenile idiopathic arthritis, according to data published in Pediatric Rheumatology.

“Antibiotics are one of the most common prescription drugs in children and it seems to disrupt with the normal maturation of the microbiome,” Erik Kindgren, MD, of Skaraborg Hospital Skövde, in Sweden, and colleagues wrote. “A recent systematic review has compiled evidence that antibiotic exposure in children is associated with a reduction in wealth and/or diversity and a change in the balance between species in the microbiome with reductions in the number of commensal bacteria that are considered beneficial.”

Exposure to antibiotics in early life is associated with the later onset of JIA, according to data derived from Kindgren E, et al. Pediatr Rheumatol. 2021;doi:10.1186/s12969-021-00611-4.

“It has been shown that use of antibiotics is associated with both JIA and RA,” they added. “However, [whether] the association is due to an increased number of infections, rather than use of the antibiotic, is unknown.”

To analyze the link between antibiotic use, as well as infections, and JIA, Kindgren and colleagues examined data from the All Babies in South-east Sweden (ABIS) cohort. According to the researchers, ABIS has to date enrolled 17,055 families of children born in southeast Sweden from Oct. 1, 1997, to Oct. 1, 1999. Blood samples of the children were collected at birth and subsequently at 1, 3, 5 and 8 years. Meanwhile, parental questionnaires collected data on nutrition, infections, drug use, vaccinations and other factors at the same intervals.

For their own study, Kindgren and colleagues identified a total of 102 children with JIA. They conducted multivariable logistic regression analyses, adjusting for confounding factors, to examine the link between infections, antibiotics and later onset JIA.

According to the researchers, antibiotic use from 1 to 12 months, from 1 to 3years and from 5 to 8years was significantly associated with an increased risk for JIA.

In addition, the odds of developing JIA were three times higher among children exposed to antibiotics during their first 3years of life, compared with children who were not given antibiotics (aOR = 3.17; 95% CI, 1.11-9.03). The odds of JIA were more than twice as high in those exposed to antibiotics during the first 5years of life, compared with those not exposed (aOR = 2.18; 95% CI, 1.36-3.5). Among those exposed to antibiotics during the first 8 years of life, the odds for JIA were 78% higher than those not exposed (aOR = 1.78; 95% CI, 1.15-2.73).

Meanwhile, infection during fetal life or childhood demonstrated no significant association with JIA risk after confounder adjustment.

“This study shows that exposure to antibiotics early in life is associated with later onset of JIA in a large birth cohort from the general population,” Kindgren and colleagues wrote. “The relationship was dose dependent. Infections per se during childhood showed no significant association with the risk of developing JIA after adjusting for confounders. The findings suggest a causal relationship between use of antibiotics specifically and the development of JIA. Irrespective of mediating mechanisms, these results suggest that restrictive antibiotic policies during the first years of life should be advisable.”