Long-Term Antibiotic Use Linked to Increased Risk for RA

TOPLINE:

Long-term antibiotic usage is associated with an increased risk for rheumatoid arthritis (RA).

METHODOLOGY:

• Researchers conducted a population-based retrospective cohort study using data from the National Health Insurance Service–National Health Screening Cohort of Korea database to examine the association between antibiotic usage and the risk for RA.
• A total of 311,547 participants aged ≥ 40 years were included, with antibiotic exposure assessed from 2003 to 2007 and follow-up conducted from 2008 to the date of newly diagnosed RA or death or up to December 2019.
• Antibiotic exposure was categorized by the cumulative days of antibiotic prescription (0, 1-14, 15-30, 31-90, or ≥ 91 days) and the number of antibiotic classes prescribed (0, 1, 2, 3, or ≥ 4 classes).
• The primary outcome was the diagnosis of RA, identified using the International Classification of Diseases, 10th Revision diagnostic code and antirheumatic drug prescriptions.

TAKEAWAY:

• Antibiotic exposure was associated with a 32% increase in the risk for RA (adjusted hazard ratio [aHR], 1.32; 95% CI, 1.25-1.40).
• Participants using antibiotics for ≥ 91 days had a higher risk for RA than nonusers (aHR, 1.79; 95% CI, 1.67-1.92) and those with 1-14 days of exposure (aHR, 1.41; 95% CI, 1.35-1.48).
• Participants who were prescribed four or more antibiotic classes had a 61% increased risk for RA compared with nonusers (aHR, 1.61; 95% CI, 1.51-1.71) and a 32% increased risk compared with those who were prescribed only one type of antibiotic (aHR, 1.32; 95% CI, 1.26-1.38).
• Sensitivity analyses confirmed the robustness of these findings across different exposure and washout periods (P for trend

IN PRACTICE:

“It may suggest that proper prescription of antibiotics is crucial and that ongoing surveillance of drug safety is necessary,” the authors wrote.

SOURCE:

This study was led by Sun Jae Park, Seoul National University Hospital, Seoul National University College of Medicine, and Minkyung Kim, College of Nursing, Korea University, Seoul, Republic of Korea. It was published online on September 28, 2024, in Rheumatology.

LIMITATIONS:

The study assumed antibiotic utilization on the basis of prescriptions, which may not have reflected the actual intake by the participants. There was a discrepancy between the prescribed amount of antibiotics and the actual amount of antibiotics consumed, as patients often discontinued taking antibiotics once they felt better. The investigation was limited to antibiotic exposure from 2002 owing to database constraints.

DISCLOSURES:

The study was supported by a fund from the research program of the Korea Medical Institute. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.