Antibiotics tied to excess risk for rheumatoid arthritis

  • Sultan AA & al.
  • BMC Med
  • 7 Aug 2019

  • International Clinical Digest
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Takeaway

  • Antibiotic use increases the risk of rheumatoid arthritis (RA) by 60%, according to a very large case-control study of primary care patients.

Why this matters

  • Clinicians should limit antibiotic prescriptions.
  • The relationship between antibiotics and RA may be mediated by altered gut microbiota.

Study design

  • Nested population-based, case-control study of 22,677 cases of RA vs 90,013 controls (matched on age, sex, and general practice) from the primary care Clinical Practice Research Datalink in the UK (1995-2017).
  • Median follow-up was 10 years before diagnosis of RA.
  • Funding: National Institute for Health Research; others.

Key results

  • Exposure to antibiotics (vs no exposure) was associated with a 60% increased risk of RA onset (aOR=1.60; 95% CI, 1.51-1.68), with all antibiotic classes and all types of infections implicated.
  • The risk increased with increasing number of prescriptions (e.g., 4 prescriptions [aOR=0.56; 95% CI, 2.39-2.74] vs 1 prescription [aHR=1.40; 95% CI, 1.32-1.48]).
  • Bactericidal antibiotics were associated with higher odds than bacteriostatic antibiotics (aOR=1.45; 95% CI, 1.39-1.51 vs aOR=1.31; 95% CI, 1.27-1.36).
  • Also implicated were antiviral vs no antiviral (OR=1.27; 95% CI, 1.20-1.35) and antifungal vs no antifungal medications (OR=1.19; 95% CI, 1.14-1.24).

Limitations

  • Observational design.