Background: Juvenile idiopathic arthritis (JIA) is the most common type of arthritis in children and can be life-altering. The etiology of JIA is unknown, though current research focuses on a combination of genetic factors, immune mechanisms, and environmental triggers. Evidence has shown a genetic predisposition to JIA, but this only accounts for a portion of JIA cases. That leaves environmental triggers and immune mechanisms. One environmental trigger being investigated is childhood antibiotic exposure and has already been implicated in the pathogenesis of certain autoimmune diseases like type 1 diabetes and Crohn disease. The goal of this paper is to examine the relationship between newly diagnosed JIA and childhood antibiotic exposure.
Methods: An exhaustive search using MEDLINE-Ovid, MEDLINE-PubMed, and Web of Science was performed using the keywords: juvenile idiopathic arthritis and antibiotic exposure. The resulting studies were then screened for eligibility criteria. Once screened, the remaining studies were then thoroughly assessed and appraised for quality of evidence using The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines.
Results: Two studies were included in this systematic review, meeting both inclusion and exclusion criteria. The first study was a case-control study which looked at 1298 cases and 5179 appropriate controls in Finland. Researchers found that the risk of JIA increased with the number of antibiotic purchases, with antibiotic groups lincosamides and cephalosporins showing the strongest association with JIA. Lastly, overall exposure to antibiotics before 2 years of age was associated with an increased risk of JIA. Another case-control study looked at 152 cases and 1520 appropriate controls in the UK and concluded that any antibiotic exposure was associated with an increased risk of developing JIA and was dose-dependent, with the relationship strongest within 1 year of diagnosis. These findings did not change when adjusting for the number or type of infections. In addition, antibiotic-treated upper respiratory infections (URIs) were more strongly associated with JIA than untreated URIs.
Conclusion: Clinically, this research provides utility for providers seeing younger patients receiving frequent antibiotics for infections. It could be a possible recommendation that providers screen these patients more frequently for signs and symptoms of JIA because of the association shown in the research presented in this analysis. Further research needs to be conducted in order to truly uncover the association between antibiotic exposure and JIA and the etiology of JIA and its specific categories. Future studies should also be conducted to follow patients for a longer period of time.
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