Specific Antibiotic Use Associated With Rheumatoid Arthritis Diagnosis, Flare Risk

The following article is a part of conference coverage from the 2019 American College of Rheumatology/Association of Rheumatology Professionals (ACR/ARP) Annual Meeting, being held in Atlanta, Georgia. The team at Rheumatology Advisor will be reporting on the latest news and research conducted by leading experts in rheumatology. Check back for more from the 2019 ACR/ARP Annual Meeting.

ATLANTA — Treatment with broad-spectrum beta-lactam antibiotics, including sulfonamide and trimethoprim, may be associated with a diagnosis of rheumatoid arthritis (RA) or increased risk for RA flares, according to research results presented at the 2019 American College of Rheumatology/Association of Rheumatology Professionals (ACR/ARP) Annual Meeting, held November 8 to 13, 2019, in Atlanta, Georgia.

Researchers sought to determine the association of antibiotic use with either RA diagnosis or RA flares. Data were collected from the Catalan Information System for Research in Primary Care (SIDIAP) and United Kingdom Clinical Practice Research Datalink (CPRD) databases; investigators conducted a case-control study and a self-controlled case series with each database, respectively.

Data from 13,920 patients with RA and 69,535 healthy controls in the SIDIAP database were assessed. Investigators found that the use of either beta-lactams or quinolones in 2 years before diagnosis was associated with RA (odds ratio [OR], 1.23 and 1.32, respectively; P <.0001). Beta-lactams showed a consistent dose-response gradient over time and an association with recency of use (current OR, 1.82; recent OR, 1.54; previous use OR, 1.20; P <.0001).

In addition, data from 1192 patients with RA with ≥1 flare(s) were evaluated from the CPRD database with 31,992 patients. Sulfonamide and trimethoprim were both associated with an increased risk for RA flare at 29 to 90 days, 91 to 183 days, and 184 to 365 days after initiation of antibiotic treatment (incidence rate ratio [IRR], 1.71, 1.57, and 1.44, respectively; P =.012, .025, and .033, respectively).

No other groups of antibiotics were associated with either RA or RA flare risk.

Overall, sulfonamide and trimethoprim were associated with a 70% increased risk for RA flares at 1 to 3 months, up to 12 months after treatment.

“We hypothesize that antibiotic use is a surrogate of a pathogenic bacterial infection in index RA and that the delayed onset of RA flares after specific antibiotics is mediated through the gut or urinary microbiomes,” the researchers concluded. “Further [epidemiologic] and mechanistic research is also needed to determine whether acute infections are associated with RA.”

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Reference

Nagra N, Robinson D, Delmestri A, et al. Antibiotic use and the development of rheumatoid arthritis (RA) and the risk of RA flares: case-control and self-controlled case series studies in two national electronic patient databases (SIDIAP and CPRD). Presented at: 2019 ACR/ARP Annual Meeting; November 8-13, 2019; Atlanta, GA. Abstract 2824.