Researchers from Keele University and the Quadram Institute in a new study has provided evidence that antibiotic usage is associated with an increased risk of developing rheumatoid arthritis. Rheumatoid arthritis (RA) is the most common type of autoimmune arthritis. It is caused when the immune system is not functioning properly. RA causes pain and swelling in the wrist and small joints of the hand and feet. About 1.2 percent of the total global population are inflicted by it and normally individuals between the ages of 35 to 60 start experiencing the symptoms.
The researchers by using Big Data Analysis of primary care medical records, found that the odds of developing rheumatoid arthritis were 65% higher in those exposed to antibiotics than in those not exposed. The odds increased with the number of antibiotics treatments, and how recently they were taken.
Rheumatoid arthritis affects 450,000 people in Britain alone and this study suggests it affects people who have taken antibiotics. Rheumatoid arthritis is also likely to be caused by a complex mix of genetics and different environmental factors. The study does open up a new avenue of exploration to finding the triggers, which could be vital in the search for ways of preventing this condition. Although this study was extensive and covered a large base, it is still hard to say for sure whether it is the antibiotics alone that increase the risk, or a combination of factors.
The type of infection was important. Upper respiratory tract infections treated with antibiotics were more associated with rheumatoid arthritis cases, but this association was not seen in untreated cases. The analysis of the type of antibiotic showed that all classes increased the risk of developing rheumatoid arthritis, so this suggests the risk could be derived from the antibiotics. This has also been seen in other recent studies associating antibiotic usage with an increased risk of other autoimmune conditions, including type 1 diabetes and autoimmune liver disease.
As well as targeting the bacteria behind infections, antibiotics affect the microbiome. This complex ecosystem of microbes helps maintain our own health and plays an important role in modulating the immune system. A number of new studies have found that the microbiome in individuals with rheumatoid arthritis is less diverse, but this is the first study that has investigated the effect of antibiotic usage.
"This exciting study offers another glimpse into the complexity of understanding rheumatoid arthritis, opening the door for future work in this area. New collaborations, such as the one between the Quadram Institute and Keele University, allow exciting new interdisciplinary research that is needed to progress understanding in this field.The more we learn about the complexity of the microbiome, and how factors including antibiotics impact these diverse microbial ecosystems, the more insights we have into how this may alter key health outcomes. The strategy now is to unpick the mechanisms that link the microbes to different conditions, including Rheumatoid Arthritis, so that researchers can develop new drugs and treatment protocols." commented Professor Christian Mallen, from Keele University in an interview with Thailand Medical News.
In Thailand the problem of RA could be more serious as antibiotics is greatly misused in the country as its easily available at most pharmacies and is not classified as a controlled drug. People often self-prescribe and in most cases
wrongly. The health authorities should change regulatory issues about antibiotics in Thailand and let it only be dispensed by doctors .
Reference: Alyshah Abdul Sultan et al. Antibiotic use and the risk of rheumatoid arthritis: a population-based case-control study, BMC Medicine (2019). DOI: 10.1186/s12916-019-1394-6