Antibiotics May Increase Risk of Juvenile Arthritis Interview with:
Dr. Daniel B Horton, MD
Division of Pediatric Rheumatology
Department of Pediatrics
Nemours Dupont Pediatrics Wilmington, Delaware

Medical Research: What is the background for this study? What are the main findings?

Dr. Horton: The reasons why children develop juvenile arthritis (JIA) are unclear. To date, genetic variation accounts for only a minority of disease incidence, and no environmental factor has consistently been associated with juvenile arthritis. There is growing understanding about the role of microbiome disturbance in the development of multiple diseases, including obesity, inflammatory bowel disease, and rheumatoid arthritis. Exposure to antibiotics, a known disruptor of the human microbiome, has been linked to pediatric conditions including inflammatory bowel disease, asthma, and obesity.

We showed that antibiotic prescriptions are associated with the development of new JIA diagnosis in a large general pediatric population, after accounting for history of infection and other relevant factors. This association is stronger for those who have received multiple courses of antibiotics and appears specific for antibacterial antibiotics, such as penicillins and sulfa drugs.

Medical Research
: What should clinicians and patients take away from your report?

Dr. Horton: This study suggests a potential role for antibiotics in the development of arthritis in children, possibly through disruption of the microbiome. However, infections may also help explain this association, as least in part. Infections may play a direct role in triggering juvenile arthritis, and antibiotics could reflect this risk. Additionally, children who ultimately develop JIA may have an abnormal immune system earlier in life that puts them at risk for infections or more serious infections that warrant antibiotics.

Approximately a quarter of outpatient antibiotic prescriptions for children are probably not medically necessary. If a mechanistic link between antibiotic exposure and JIA can be confirmed, this might implicate antibiotic exposure as a modifiable risk factor in the prevention of juvenile arthritis.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Horton: Future studies should examine whether this association changes for different categories of juvenile arthritis, which likely have different biologic origins, both genetic and environmental. Future research should also work to understand the mechanism that links antibiotics and juvenile arthritis and whether this reflects a role for the microbiome in the disease process.


American College of Rheumatology Annual Scientific Meeting 2014 abstract discussing:

Antibiotic use in children linked to juvenile idiopathic arthritis