Antibiotics and Kids' Risk for Juvenile Arthritis

By Pam Harrison
WebMD Health News

Nov. 18, 2014 -- Antibiotics, which treat bacterial infections, may raise a child's risk of getting juvenile idiopathic arthritis, a disease that causes inflamed, swollen joints. That's according to investigators reporting at the American College of Rheumatology 2014 Annual Meeting in Boston.

Bacteria are among the tiny organisms called microbes, and our bodies are filled with them. The new study suggests that changes in the body's unique collection of microbes, known as the microbiome, might be a culprit behind getting the juvenile arthritis.

"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 -- and that includes inflammatory bowel disease and rheumatoid arthritis and perhaps psoriatic arthritis -- all of which have some common features with juvenile arthritis," says Daniel Horton, MD, from the University of Pennsylvania in Philadelphia.

The link between antibiotics and the childhood disease "increased with each additional prescription," he tells Medscape Medical News.

The study "adds to a growing literature on the potential harms of antibiotic use in children," Horton says.

Study Details

Investigators used the Health Improvement Network, a medical records database in the United Kingdom, to identify people under 16 who were newly diagnosed with arthritis.

The 153 children with juvenile arthritis were matched, for age and sex, with 1,530 others who didn't have the disease.

The link the researchers found was similar for different classes of antibiotics. But there was no link between getting arthritis and taking medicines from other drug classes, such as antifungal or antiviral drugs.

Horton says, though, the researchers couldn't rule out the possibility that the infection antibiotics were prescribed for might have contributed to the development of disease, or that children who got arthritis early in life have a higher risk for infection, or at least more severe infection.

"It's always good to find another reason not to prescribe antibiotics inappropriately to children, but the fact is that antibiotics can be very useful drugs in certain situations," Horton says.

Still, the reasons certain children get arthritis remain poorly understood, he says, and genetics explain less than half of the cases of it.

If the link the researchers found gets confirmed, doctors and parents might want to take extra care to avoid treating a child with antibiotics when possible, Horton says. Doing that " might be one of the few ways we have to prevent this life-changing disease," he says.

Second Opinion

Matthew Stoll, MD, agrees that changes in gut bacteria caused by antibiotic use might contribute to kids getting juvenile arthritis. Stoll is an associate professor of pediatrics at the University of Alabama at Birmingham. He was not involved in the study.

Some bacteria appear to boost inflammation, while others have anti-inflammatory effects he says. Changing gut bacteria to the point where there is a lot more pro-inflammatory bacteria "could potentially lead to arthritis and other autoimmune diseases."

He agrees with Horton that doctors have every reason to be cautious about prescribing antibiotics to children.

"There were reasons to be cautious about prescribing antibiotics to children even before this study came out. If a child doesn't have a bacterial infection and you give an antibiotic, you are exposing the child to unnecessary medicines." And that could raise the odds that antibiotics lose their power to treat a future infection, he says.

"Now there are potentially other reasons to be cautious about giving antibiotics to children, and this is another good one," he said.

These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.

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SOURCES: American College of Rheumatology (ACR) 2014 Annual Meeting, Boston, Nov. 14 - 19, 2014. Matthew Stoll, MD, associate professor of pediatrics, University of Alabama at Birmingham.

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