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Zhong X, Palin V, Ashcroft DM, Goldacre B, MacKenna B, Mehrkar A, Bacon SCJ, Massey J, Inglesby P, Hand K, Pate A, van Staa TP. Risk of emergency hospital admission related to adverse events after antibiotic treatment in adults with a common infection: impact of COVID-19 and derivation and validation of risk prediction models. BMC Med 2024; 22:277. [PMID: 38956603 PMCID: PMC11220965 DOI: 10.1186/s12916-024-03480-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/12/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND With the global challenge of antimicrobial resistance intensified during the COVID-19 pandemic, evaluating adverse events (AEs) post-antibiotic treatment for common infections is crucial. This study aims to examines the changes in incidence rates of AEs during the COVID-19 pandemic and predict AE risk following antibiotic prescriptions for common infections, considering their previous antibiotic exposure and other long-term clinical conditions. METHODS With the approval of NHS England, we used OpenSAFELY platform and analysed electronic health records from patients aged 18-110, prescribed antibiotics for urinary tract infection (UTI), lower respiratory tract infections (LRTI), upper respiratory tract infections (URTI), sinusitis, otitis externa, and otitis media between January 2019 and June 2023. We evaluated the temporal trends in the incidence rate of AEs for each infection, analysing monthly changes over time. The survival probability of emergency AE hospitalisation was estimated in each COVID-19 period (period 1: 1 January 2019 to 25 March 2020, period 2: 26 March 2020 to 8 March 2021, period 3: 9 March 2021 to 30 June 2023) using the Kaplan-Meier approach. Prognostic models, using Cox proportional hazards regression, were developed and validated to predict AE risk within 30 days post-prescription using the records in Period 1. RESULTS Out of 9.4 million patients who received antibiotics, 0.6% of UTI, 0.3% of URTI, and 0.5% of LRTI patients experienced AEs. UTI and LRTI patients demonstrated a higher risk of AEs, with a noted increase in AE incidence during the COVID-19 pandemic. Higher comorbidity and recent antibiotic use emerged as significant AE predictors. The developed models exhibited good calibration and discrimination, especially for UTIs and LRTIs, with a C-statistic above 0.70. CONCLUSIONS The study reveals a variable incidence of AEs post-antibiotic treatment for common infections, with UTI and LRTI patients facing higher risks. AE risks varied between infections and COVID-19 periods. These findings underscore the necessity for cautious antibiotic prescribing and call for further exploration into the intricate dynamics between antibiotic use, AEs, and the pandemic.
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Affiliation(s)
- Xiaomin Zhong
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, the University of Manchester, Manchester, M13 9PL, UK.
- Applied Health Research Unit, Nuffield Department of Population Health, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, OX3 7LF, UK.
| | - Victoria Palin
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, the University of Manchester, Manchester, M13 9PL, UK
- Maternal and Fetal Research Centre, Division of Developmental Biology and Medicine, the University of Manchester, St Marys Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
- NHS England, Wellington House, Waterloo Road, London, SE1 8UG, UK
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Sebastian C J Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Jon Massey
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Peter Inglesby
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Kieran Hand
- Pharmacy Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- NHS England, Wellington House, Waterloo Road, London, SE1 8UG, UK
| | - Alexander Pate
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, the University of Manchester, Manchester, M13 9PL, UK
| | - Tjeerd Pieter van Staa
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, the University of Manchester, Manchester, M13 9PL, UK
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2
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Alizadeh M, Wong U, Siaton BC, Patil SA, George L, Raufman JP, Scott WH, von Rosenvinge EC, Ravel J, Cross RK. Inflammatory Bowel Disease-Associated Arthritis Is Associated with Concomitant Autoimmune and Inflammatory Disorders. Dig Dis Sci 2024:10.1007/s10620-024-08478-7. [PMID: 38902460 DOI: 10.1007/s10620-024-08478-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/05/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Extraintestinal Manifestations (EIMs) are a common and potentially debilitating complication of Inflammatory Bowel Diseases (IBD), sometimes requiring additional treatment beyond those used to control intestinal disease. IBD-associated arthritis (IAA), a form of spondyloarthritis, is associated with several factors including disease location, sex, and IBD type. However, much remains unknown about other clinical factors predicting development of EIMs. Our goal was to identify additional factors associated with IAA. METHODS Participants in the LOCATION-IBD cohort were included in this analysis. We performed univariate and multivariate analysis of demographics, clinical data, and patient-reported outcomes data. RESULTS The LOCATION-IBD cohort included 182 participants with (n = 53) and without (n = 110) joint EIMs and with joint pain of unclear etiology (n = 19). In a multivariate analysis comparing those with and without joint EIMs, female sex (OR = 2.5, p = 0.014), the presence of concomitant autoimmune and inflammatory disorders (OR = 2.5, p = 0.038), and Crohn's disease (OR = 2.9, p = 0.026) were associated with the presence of joint EIMs. CONCLUSION This analysis reveals patients with IAA are more likely to have concomitant autoimmune disorders. Further studies are needed to confirm this association, understand the mechanisms underlying the common pathogenesis of these concurrent disorders, and evaluate their impact on the treatment of IAA.
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Affiliation(s)
- Madeline Alizadeh
- Institute for Genome Sciences, University of Maryland School of Medicine, HSF III, 670 W Baltimore St, Baltimore, MD, 21201, USA.
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD, 21201, USA.
- Department of Veterans Affairs, Veterans Affairs Maryland Health Care System, Baltimore, MD, USA.
| | - Uni Wong
- Department of Veterans Affairs, Washington DC Veterans Health Administration, Washington, DC, USA
| | - Bernadette C Siaton
- Department of Veterans Affairs, Veterans Affairs Maryland Health Care System, Baltimore, MD, USA
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Seema A Patil
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD, 21201, USA
- Department of Veterans Affairs, Veterans Affairs Maryland Health Care System, Baltimore, MD, USA
| | - Lauren George
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD, 21201, USA
- Department of Veterans Affairs, Veterans Affairs Maryland Health Care System, Baltimore, MD, USA
| | - Jean-Pierre Raufman
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD, 21201, USA
- Department of Veterans Affairs, Veterans Affairs Maryland Health Care System, Baltimore, MD, USA
| | - William H Scott
- Department of Veterans Affairs, Veterans Affairs Maryland Health Care System, Baltimore, MD, USA
| | - Erik C von Rosenvinge
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD, 21201, USA
- Department of Veterans Affairs, Veterans Affairs Maryland Health Care System, Baltimore, MD, USA
| | - Jacques Ravel
- Institute for Genome Sciences, University of Maryland School of Medicine, HSF III, 670 W Baltimore St, Baltimore, MD, 21201, USA
- Department of Microbiology & Immunology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Raymond K Cross
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD, 21201, USA
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3
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Ria F, Delogu G, Ingrosso L, Sali M, Di Sante G. Secrets and lies of host-microbial interactions: MHC restriction and trans-regulation of T cell trafficking conceal the role of microbial agents on the edge between health and multifactorial/complex diseases. Cell Mol Life Sci 2024; 81:40. [PMID: 38216734 PMCID: PMC11071949 DOI: 10.1007/s00018-023-05040-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 10/04/2023] [Accepted: 11/06/2023] [Indexed: 01/14/2024]
Abstract
Here we critically discuss data supporting the view that microbial agents (pathogens, pathobionts or commensals alike) play a relevant role in the pathogenesis of multifactorial diseases, but their role is concealed by the rules presiding over T cell antigen recognition and trafficking. These rules make it difficult to associate univocally infectious agents to diseases' pathogenesis using the paradigm developed for canonical infectious diseases. (Cross-)recognition of a variable repertoire of epitopes leads to the possibility that distinct infectious agents can determine the same disease(s). There can be the need for sequential infection/colonization by two or more microorganisms to develop a given disease. Altered spreading of infectious agents can determine an unwanted activation of T cells towards a pro-inflammatory and trafficking phenotype, due to differences in the local microenvironment. Finally, trans-regulation of T cell trafficking allows infectious agents unrelated to the specificity of T cell to modify their homing to target organs, thereby driving flares of disease. The relevant role of microbial agents in largely prevalent diseases provides a conceptual basis for the evaluation of more specific therapeutic approaches, targeted to prevent (vaccine) or cure (antibiotics and/or Biologic Response Modifiers) multifactorial diseases.
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Affiliation(s)
- F Ria
- Department of Translational Medicine and Surgery, Section of General Pathology, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - G Delogu
- Mater Olbia Hospital, 07026, Olbia, Italy
- Department of Biotechnological, Basic, Intensivological and Perioperatory Sciences-Section of Microbiology, Università Cattolica del S Cuore, 00168, Rome, Italy
| | - L Ingrosso
- Department Infectious Diseases, Istituto Superiore di Sanità, 00161, Rome, Italy
- European Program for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - M Sali
- Department of Biotechnological, Basic, Intensivological and Perioperatory Sciences-Section of Microbiology, Università Cattolica del S Cuore, 00168, Rome, Italy
- Department of Laboratory and Infectivology Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - G Di Sante
- Department of Medicine and Surgery, Section of Human, Clinical and Forensic Anatomy, University of Perugia, 60132, Perugia, Italy.
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Vasilakis-Scaramozza C, Hagberg KW, Persson R, Kafatos G, Maskell J, Neasham D, Jick S. Comparison of Rheumatoid Arthritis Information Recorded in UK CPRD Aurum and CPRD GOLD Databases (Companion Paper 3). Clin Epidemiol 2023; 15:1207-1218. [PMID: 38126003 PMCID: PMC10731986 DOI: 10.2147/clep.s434831] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
Purpose To report distribution of codes associated with a rheumatoid arthritis (RA) diagnosis recorded in Clinical Practice Research Datalink (CPRD) Aurum compared to the previously validated CPRD GOLD database as a critical step toward making decisions about CPRD Aurum's suitability for medical research. Patients and Methods We analyzed the distribution of codes for RA diagnoses, labs, and treatments in the new CPRD Aurum database, compared to the CPRD GOLD database by selecting relevant indicators of RA diagnosis, treatment, and clinical care. We included all patients in England in CPRD Aurum and CPRD GOLD with an incident diagnosis code for RA on or after 1 January 2005 and at least two years recorded data before first RA diagnosis. Results We found 53,083 and 18,167 patients with a new diagnosis code for RA in CPRD Aurum and CPRD GOLD, respectively. In both databases approximately 67% were female with similar mean ages at first diagnosis. There were few differences in RA-related recording patterns between the two data sources. Before first RA diagnosis, CPRD Aurum patients had more RA-specific labs and other supporting clinical codes. After diagnosis, CPRD Aurum patients had more RA diagnoses coded and more often had 10+ general RA labs than patients in CPRD GOLD. More CPRD GOLD patients had 10+ prescriptions for conventional disease-modifying antirheumatic drugs (cDMARD) compared to CPRD Aurum. Otherwise, the distribution of drugs used to treat RA was similar between databases. The standardized incidence of RA was similar between databases. Conclusion Overall, among patients with a diagnosis code for RA, recording of diagnoses, prescription drugs, and labs were similar between CPRD Aurum and CPRD GOLD. Slight differences were found for a few variables, but overall, we found consistency between the databases. In addition, standardized incidence of RA was similar between databases.
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Affiliation(s)
| | | | - Rebecca Persson
- Epidemiology, Boston Collaborative Drug Surveillance Program, Lexington, MA, USA
| | - George Kafatos
- Center for Observational Research, Amgen Ltd, Uxbridge, UK
| | - Joe Maskell
- Center for Observational Research, Amgen Ltd, Uxbridge, UK
| | - David Neasham
- Center for Observational Research, Amgen Ltd, Uxbridge, UK
| | - Susan Jick
- Epidemiology, Boston Collaborative Drug Surveillance Program, Lexington, MA, USA
- Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Lin L, Zhang K, Xiong Q, Zhang J, Cai B, Huang Z, Yang B, Wei B, Chen J, Niu Q. Gut microbiota in pre-clinical rheumatoid arthritis: From pathogenesis to preventing progression. J Autoimmun 2023; 141:103001. [PMID: 36931952 DOI: 10.1016/j.jaut.2023.103001] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/30/2022] [Accepted: 01/31/2023] [Indexed: 03/17/2023]
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by progressive polyarthritis that leads to cartilage and bone damage. Pre-clinical RA is a prolonged state before clinical arthritis and RA develop, in which autoantibodies (antibodies against citrullinated proteins, rheumatoid factors) can be present due to the breakdown of immunologic self-tolerance. As early treatment initiation before the onset of polyarthritis may achieve sustained remission, optimize clinical outcomes, and even prevent RA progression, the pre-clinical RA stage is showing the prospect to be the window of opportunity for RA treatment. Growing evidence has shown the role of the gut microbiota in inducing systemic inflammation and polyarthritis via multiple mechanisms, which may involve molecular mimicry, impaired intestinal barrier function, gut microbiota-derived metabolites mediated immune regulation, modulation of the gut microbiota's effect on immune cells, intestinal epithelial cells autophagy, and the interaction between the microbiome and human leukocyte antigen alleles as well as microRNAs. Since gut microbiota alterations in pre-clinical RA have been reported, potential therapies for modifying the gut microbiota in pre-clinical RA, including natural products, antibiotic therapy, fecal microbiota transplantation, probiotics, microRNAs therapy, vitamin D supplementation, autophagy inducer-based treatment, prebiotics, and diet, holds great promise for the successful treatment and even prevention of RA via altering ongoing inflammation. In this review, we summarized current studies that include pathogenesis of gut microbiota in RA progression and promising therapeutic strategies to provide novel ideas for the management of pre-clinical RA and possibly preventing arthritis progression.
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Affiliation(s)
- Liyan Lin
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Keyi Zhang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Qiao Xiong
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Infection Control, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Junlong Zhang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Bei Cai
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zhuochun Huang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Yang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Wei
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Chen
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China.
| | - Qian Niu
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China.
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6
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Moir J, Hyman M, Wang J, Flores A, Skondra D. The Association of Antibiotic Use and the Odds of a New-Onset ICD Code Diagnosis of Age-Related Macular Degeneration: A Large National Case-Control Study. Invest Ophthalmol Vis Sci 2023; 64:14. [PMID: 37682568 PMCID: PMC10500369 DOI: 10.1167/iovs.64.12.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/16/2023] [Indexed: 09/09/2023] Open
Abstract
Purpose The widespread use of antibiotics has many well-documented impacts on the human microbiome, which may be associated with the development of various inflammatory diseases. Despite age-related macular degeneration (AMD) featuring an inflammatory pathogenesis, the relationship between antibiotics and AMD has remained unexplored. We conducted the first study to determine the association between antibiotic exposure and a new-onset International Classification of Diseases (ICD) diagnosis of AMD. Methods We performed a case-control analysis of patients aged 55 and older with new-onset AMD between 2008 and 2017 from a nationwide commercial health insurance claims database. Exposure to antibiotics in the two years before the index date was determined for cases and controls matched one-to-one by age, year, region, anemia, hypertension, and a comorbidity index. Conditional multivariable logistic regression, adjusted for AMD risk factors, was performed to calculate odd ratios (OR) and 95% confidence intervals (CI). Results Among the antibiotic classes, exposure to aminoglycosides (OR = 1.24; 95% CI, 1.22-1.26) and fluoroquinolones (OR = 1.13; 95% CI, 1.12-1.14) was associated with the greatest odds of a new-onset ICD code diagnosis of AMD. Broad-spectrum antibiotics were associated with nearly three times greater odds of a new-onset ICD code diagnosis of AMD (OR = 1.15; 95% CI, 1.13-1.16) compared to narrow-spectrum antibiotics (OR = 1.05; 95% CI, 1.03-1.07). We also identified a frequency- and duration-dependent association, with a greater cumulative number of antibiotic prescriptions or day supply of antibiotics conferring increased odds of a new-onset ICD code diagnosis of AMD. Conclusions Greater cumulative exposure to antibiotics, particularly fluoroquinolones, aminoglycosides, and those with broader-spectrum coverage, may be associated with the development of AMD, a finding that requires further investigation using prospective studies.
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Affiliation(s)
- John Moir
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, United States
| | - Max Hyman
- The Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois, United States
| | - Jessie Wang
- Department of Ophthalmology and Visual Science, University of Chicago Medicine, Chicago, Illinois, United States
| | - Andrea Flores
- The Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois, United States
| | - Dimitra Skondra
- Department of Ophthalmology and Visual Science, University of Chicago Medicine, Chicago, Illinois, United States
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7
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Yang YT, Wong D, Ashcroft DM, Massey J, MacKenna B, Fisher L, Mehrkar A, Bacon SCJ, Hand K, Zhong X, Fahmi A, Goldacre B, van Staa T, Palin V. Repeated antibiotic exposure and risk of hospitalisation and death following COVID-19 infection (OpenSAFELY): a matched case-control study. EClinicalMedicine 2023; 61:102064. [PMID: 37528841 PMCID: PMC10388579 DOI: 10.1016/j.eclinm.2023.102064] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/02/2023] [Accepted: 06/09/2023] [Indexed: 08/03/2023] Open
Abstract
Background Identifying potential risk factors related to severe COVID-19 outcomes is important. Repeated intermittent antibiotic use is known be associated with adverse outcomes. This study aims to examine whether prior frequent antibiotic exposure is associated with severe COVID-19 outcomes. Methods With the approval of NHS England, we used the OpenSAFELY platform, which integrated primary and secondary care, COVID-19 test, and death registration data. This matched case-control study included 0.67 million patients (aged 18-110 years) from an eligible 2.47 million patients with incident COVID-19 by matching with replacement. Inclusion criteria included registration within one general practice for at least 3 years and infection with incident COVID-19. Cases were identified according to different severity of COVID-19 outcomes. Cases and eligible controls were 1:6 matched on age, sex, region of GP practice, and index year and month of COVID-19 infection. Five quintile groups, based on the number of previous 3-year antibiotic prescriptions, were created to indicate the frequency of prior antibiotic exposure. Conditional logistic regression used to compare the differences between case and control groups, adjusting for ethnicity, body mass index, comorbidities, vaccination history, deprivation, and care home status. Sensitivity analyses were done to explore potential confounding and the effects of missing data. Findings Based on our inclusion criteria, between February 1, 2020 and December 31, 2021, 98,420 patients were admitted to hospitals and 22,660 died. 55 unique antibiotics were prescribed. A dose-response relationship between number of antibiotic prescriptions and risk of severe COVID-19 outcome was observed. Patients in the highest quintile with history of prior antibiotic exposure had 1.80 times greater odds of hospitalisation compared to patients without antibiotic exposure (adjusted odds ratio [OR] 1.80, 95% Confidence Interval [CI] 1.75-1.84). Similarly, the adjusted OR for hospitalised patients with death outcomes was 1.34 (95% CI 1.28-1.41). Larger number of prior antibiotic type was also associated with more severe COVID-19 related hospital admission. The adjusted OR of quintile 5 exposure (the most frequent) with more than 3 antibiotic types was around 2 times larger than quintile 1 (only 1 type; OR 1.80, 95% CI 1.75-1.84 vs. OR 1.03, 95% CI 1.01-1.05). Interpretation Our observational study has provided evidence that antibiotic exposure frequency and diversity may be associated with COVID-19 severity, potentially suggesting adverse effects of repeated intermittent antibiotic use. Future work could work to elucidate causal links and potential mechanisms. Antibiotic stewardship should put more emphasis on long-term antibiotic exposure and its adverse outcome to increase the awareness of appropriate antibiotics use. Funding Health Data Research UK and National Institute for Health Research.
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Affiliation(s)
- Ya-Ting Yang
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
| | - David Wong
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Darren M. Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jon Massey
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Louis Fisher
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sebastian CJ. Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - the OpenSAFELY collaborative
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Xiaomin Zhong
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
| | - Ali Fahmi
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
| | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tjeerd van Staa
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
| | - Victoria Palin
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
- Division of Developmental Biology and Medicine, Maternal and Fetal Research Centre, University of Manchester, St Marys Hospital, Manchester, UK
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8
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Dong Y, Yao J, Deng Q, Li X, He Y, Ren X, Zheng Y, Song R, Zhong X, Ma J, Shan D, Lv F, Wang X, Yuan R, She G. Relationship between gut microbiota and rheumatoid arthritis: A bibliometric analysis. Front Immunol 2023; 14:1131933. [PMID: 36936921 PMCID: PMC10015446 DOI: 10.3389/fimmu.2023.1131933] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/14/2023] [Indexed: 03/05/2023] Open
Abstract
Introduction Rheumatoid arthritis (RA) is a multifactorial autoimmune disease. Recently, growing evidence demonstrates that gut microbiota (GM) plays an important role in RA. But so far, no bibliometric studies pertaining to GM in RA have ever been published. This study attempts to depict the knowledge framework in this field from a holistic and systematic perspective based on the bibliometric analysis. Methods Literature related to the involvement of GM in RA was searched and picked from the Web of Science Core Collection (WOSCC) database. The annual output, cooperation, hotspots, research status and development trend of this field were analyzed by bibliometric software (VOSviewer and Bibliometricx). Results 255 original research articles and 204 reviews were included in the analysis. The articles in this field that can be retrieved in WOSCC were first published in 2004 and increased year by year since then. 2013 is a growth explosion point. China and the United States are the countries with the most contributions, and Harvard University is the affiliation with the most output. Frontiers in Immunology (total citations = 603) is the journal with the most publications and the fastest growth rate. eLife is the journal with the most citations (total citations = 1248). Scher, Jose U. and Taneja, Veena are the most productive and cited authors. The research in this field is mainly distributed in the evidence, mechanism and practical application of GM participating in RA through the analysis of keywords and documents. There is sufficient evidence to prove the close relationship between GM and RA, which lays the foundation for this field. This extended two colorful and tender branches of mechanism research and application exploration, which have made some achievements but still have broad exploration space. Recently, the keywords "metabolites", "metabolomics", "acid", "b cells", "balance", "treg cells", "probiotic supplementation" appeared most frequently, which tells us that research on the mechanism of GM participating in RA and exploration of its application are the hotspots in recent years. Discussion Taken together, these results provide a data-based and objective introduction to the GM participating in RA, giving readers a valuable reference to help guide future research.
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Affiliation(s)
- Ying Dong
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Jianling Yao
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Qingyue Deng
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Xianxian Li
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Yingyu He
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Xueyang Ren
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Yuan Zheng
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Ruolan Song
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Xiangjian Zhong
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Jiamu Ma
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Dongjie Shan
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Fang Lv
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Xiuhuan Wang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Ruijuan Yuan
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Ruijuan Yuan, ; Gaimei She,
| | - Gaimei She
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Ruijuan Yuan, ; Gaimei She,
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9
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Li XY, Liu H, Zhang LY, Yang XT. The association of healthy eating index with periodontitis in National Health and Nutrition Examination Study 2011–2012. Front Nutr 2022; 9:999620. [PMID: 36225873 PMCID: PMC9549051 DOI: 10.3389/fnut.2022.999620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Aim Periodontitis is a chronic inflammatory disorder caused by periodontopathic bacteria that causes inflammation of the supporting tissues around teeth. Previous studies have found that daily dietary nutritional intake can influence the development of periodontal disease. However, research on the Healthy Eating Index’s involvement in periodontitis is limited. The purpose of this study was to look at the link between the Healthy Eating Index and periodontitis. Methods and design We examined data from the National Health and Nutrition Examination Study (NHANES), a nationally representative survey that was performed in 2-year cycles from 2011 to 2012. As part of our investigation, we used multivariate logistic regression models to investigate the independent relationship between the Healthy Eating Index and periodontitis. We used odds ratios (OR) with 95% confidence intervals to assess the significance of the connection (95% CI). Results Individuals with a lower total healthy eating index were more likely to have periodontitis. A higher healthy diet index was associated with a lower prevalence of periodontitis (OR = 0.69; 95%CI: 0.49–0.97), according to adjusted multivariate regression models. The restricted cubic spline (RCS) analysis revealed that the non-linear relationship between HEI-2015 and periodontitis was statistically significant and that high HEI-2015 reduced periodontitis prevalence. Conclusion The study’s findings revealed that dietary structure was linked to the prevalence of periodontitis. Patients with a higher Healthy Eating Index were less likely to have periodontitis. There is a need for future prospective longitudinal studies to confirm causality.
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Affiliation(s)
- Xin-yu Li
- Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Neurosurgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Liu
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Lu-yu Zhang
- The Department of Kidney Transplantation, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xi-tao Yang
- Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Xi-tao Yang,
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10
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Cronin O, Lanham-New SA, Corfe BM, Gregson CL, Darling AL, Ahmadi KR, Gibson PS, Tobias JH, Ward KA, Traka MH, Rossi M, Williams C, Harvey NC, Cooper C, Whelan K, Uitterlinden AG, O'Toole PW, Ohlsson C, Compston JE, Ralston SH. Role of the Microbiome in Regulating Bone Metabolism and Susceptibility to Osteoporosis. Calcif Tissue Int 2022; 110:273-284. [PMID: 34870723 PMCID: PMC8860778 DOI: 10.1007/s00223-021-00924-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/04/2021] [Indexed: 12/15/2022]
Abstract
The human microbiota functions at the interface between diet, medication-use, lifestyle, host immune development and health. It is therefore closely aligned with many of the recognised modifiable factors that influence bone mass accrual in the young, and bone maintenance and skeletal decline in older populations. While understanding of the relationship between micro-organisms and bone health is still in its infancy, two decades of broader microbiome research and discovery supports a role of the human gut microbiome in the regulation of bone metabolism and pathogenesis of osteoporosis as well as its prevention and treatment. Pre-clinical research has demonstrated biological interactions between the microbiome and bone metabolism. Furthermore, observational studies and randomized clinical trials have indicated that therapeutic manipulation of the microbiota by oral administration of probiotics may influence bone turnover and prevent bone loss in humans. In this paper, we summarize the content, discussion and conclusions of a workshop held by the Osteoporosis and Bone Research Academy of the Royal Osteoporosis Society in October, 2020. We provide a detailed review of the literature examining the relationship between the microbiota and bone health in animal models and in humans, as well as formulating the agenda for key research priorities required to advance this field. We also underscore the potential pitfalls in this research field that should be avoided and provide methodological recommendations to facilitate bridging the gap from promising concept to a potential cause and intervention target for osteoporosis.
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Affiliation(s)
- Owen Cronin
- Rheumatic Diseases Unit, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU, UK
| | - Susan A Lanham-New
- Nutrition, Food and Exercise Sciences Department, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Bernard M Corfe
- Population Health Sciences Institute, Human Nutrition Research Centre, Faculty of Medical Sciences, Newcastle University, Newcastle, NE2 4HH, UK
| | - Celia L Gregson
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrea L Darling
- Nutrition, Food and Exercise Sciences Department, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Kourosh R Ahmadi
- Nutrition, Food and Exercise Sciences Department, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Philippa S Gibson
- Department of Nutritional Sciences, King's College London, London, UK
| | - Jon H Tobias
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate A Ward
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Maria H Traka
- Food Databanks National Capability, Quadram Institute Bioscience, Norwich Research Park, Norwich, NR4 7UQ, UK
| | - Megan Rossi
- Department of Nutritional Sciences, King's College London, London, UK
| | - Claire Williams
- Molecular Gastroenterology Research Group, Academic Unit of Surgical Oncology, Department of Oncology and Metabolism, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, UK
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Paul W O'Toole
- School of Microbiology and APC Microbiome Ireland, University College Cork, Room 447, Food Science Building, Cork, T12 K8AF, Ireland
| | - Claes Ohlsson
- Sahlgrenska Osteoporosis Centre, Center for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Stuart H Ralston
- Rheumatic Diseases Unit, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK.
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU, UK.
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11
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Kronzer VL, Huang W, Crowson CS, Davis JM, Vassallo R, Doyle TJ, Losina E, Sparks JA. Timing of sinusitis and other respiratory tract diseases and risk of rheumatoid arthritis. Semin Arthritis Rheum 2022; 52:151937. [PMID: 35042150 PMCID: PMC8820230 DOI: 10.1016/j.semarthrit.2021.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/02/2021] [Accepted: 11/15/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the association between timing of respiratory tract diseases and risk of rheumatoid arthritis (RA). METHODS This case-control study using the Mass General Brigham Biobank matched incident RA cases, confirmed by ACR/EULAR criteria, with at least seven years preceding electronic health record (EHR) data to three controls on age, sex, and EHR history from RA diagnosis (index date). We ascertained timing (>0-5 years/>5-10 years/>10 years) of the first documented respiratory tract disease prior to index date using diagnosis codes. We estimated odds ratios (OR) with 95% confidence intervals (CI) for RA for each respiratory exposure using logistic regression models, adjusting for potential confounders. We also conducted a stratified analysis by serostatus and smoking. RESULTS We identified 625 incident RA cases (median 56 years, 75% female, 57% seropositive) and 1,875 controls. Acute sinusitis was associated with RA only in the >5 to 10 years before RA (OR 3.90, 95% CI:1.90,8.01). In contrast, pneumonia was associated with RA only in the >0 to 5 years before RA (OR 1.73, 95% CI:1.00,3.00), and chronic respiratory tract diseases only >10 years before RA (OR 1.43, 95% CI:1.00,2.05). All respiratory tract diseases tended to show a stronger association with seronegative RA than seropositive RA, although the interaction was statistically significant only for chronic sinusitis (p=0.04). Respiratory diseases showed a nonsignificantly stronger association among smokers than nonsmokers. CONCLUSION Sinusitis and other respiratory diseases are associated with increased risk of RA, especially 5 years before RA onset. RA may begin many years before clinical onset.
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Affiliation(s)
- Vanessa L Kronzer
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA.,Corresponding Author: Vanessa L. Kronzer, , 200 First Street SW, Rochester, MN 55905, P: 651-308-1523 F: 507-266-1799
| | - Weixing Huang
- Division of Rheumatology, Inflammation, and Immunity; Brigham and Women’s Hospital; Harvard Medical School; Boston, USA
| | - Cynthia S. Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - John M. Davis
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tracy J. Doyle
- Division of Pulmonary and Critical Care; Brigham and Women’s Hospital and Harvard Medical School; Boston, USA
| | - Elena Losina
- Department of Orthopedic Surgery; Brigham and Women’s Hospital; Boston, USA,Department of Biostatistics; Boston University School of Public Health; Boston, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity; Brigham and Women’s Hospital; Harvard Medical School; Boston, USA
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12
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Liu Y, Xia B, Li B, Sparks JA, He Q, Yuan J, Zhou B. No association between recent antibiotic use and risk of rheumatoid arthritis: results from two prospective cohort studies. Expert Opin Drug Saf 2022; 21:121-126. [PMID: 34403275 PMCID: PMC9989908 DOI: 10.1080/14740338.2021.1970134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Retrospective research partly characterizes the link between antibiotic use and rheumatoid arthritis (RA) development. This prospective cohort study may help reassess the association. RESEARCH DESIGN AND METHODS We included 133,125 participants from the Nurses' Health Study (NHS) and NHS II databases. Three groups were established: nonuse, short-term use (1-14 days), and middle- to long-term use (≥15 days) to explore the link. Cox regression model was chosen to evaluate the hazard ratios (HRs) for RA. RESULTS Short-term antibiotic use was not associated with the subsequent risk of RA (adjusted HR = 0.88, 95% Confidence Interval [CI] 0.38-1.38) compared to the no antibiotic use group in the multivariable adjusted model. The age-stratified model showed no sufficient evidence of increased risk in participants with middle- to long-term antibiotic use (HR = 1.32, 95% CI 0.89-1.98). The effect further attenuated to null after controlling for confounding factors (adjusted HR = 1.06, 95% CI 0.42-1.71). CONCLUSIONS We found no evidence of an association between antibiotic use and RA risk. Our findings may reduce potential concerns about increased RA risk among antibiotic users.
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Affiliation(s)
- Yuxing Liu
- Pharmacy Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
- Clinical Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Bin Xia
- Clinical Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
- Big Data Center, Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Bo Li
- Big Data Center, Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
- Guangdong Provincial Key Laboratory of Digestive Cancer Research, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Jeffrey A Sparks
- Division of Rheumatology, Immunology and Allergy, Brigham & Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Qiangsheng He
- Clinical Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
- Big Data Center, Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Jinqiu Yuan
- Clinical Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
- Big Data Center, Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Benjie Zhou
- Pharmacy Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
- Clinical Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
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13
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Mongodin EF, Saxena V, Iyyathurai J, Lakhan R, Ma B, Silverman E, Lee ZL, Bromberg JS. Chronic rejection as a persisting phantom menace in organ transplantation: a new hope in the microbiota? Curr Opin Organ Transplant 2021; 26:567-581. [PMID: 34714788 PMCID: PMC8556501 DOI: 10.1097/mot.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The microbiota plays an important role in health and disease. During organ transplantation, perturbations in microbiota influence transplant outcome. We review recent advances in characterizing microbiota and studies on regulation of intestinal epithelial barrier function and mucosal and systemic immunity by microbiota and their metabolites. We discuss implications of these interactions on transplant outcomes. RECENT FINDINGS Metagenomic approaches have helped the research community identify beneficial and harmful organisms. Microbiota regulates intestinal epithelial functions. Signals released by epithelial cells or microbiota trigger pro-inflammatory or anti-inflammatory effects on innate and adaptive immune cells, influencing the structure and function of the immune system. Assessment and manipulation of microbiota can be used for biomarkers for diagnosis, prognosis, and therapy. SUMMARY The bidirectional dialogue between the microbiota and immune system is a major influence on immunity. It can be targeted for biomarkers or therapy. Recent studies highlight a close association of transplant outcomes with microbiota, suggesting exciting potential avenues for management of host physiology and organ transplantation.
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Affiliation(s)
- Emmanuel F. Mongodin
- University of Maryland School of Medicine, Institute for Genome Sciences and Department of Microbiology & Immunology, Baltimore, MD, USA
| | - Vikas Saxena
- University of Maryland School of Medicine, Center for Vascular and Inflammatory Diseases, Departments of Surgery, Microbiology and Immunology, Baltimore, MD, USA
| | - Jegan Iyyathurai
- University of Maryland School of Medicine, Center for Vascular and Inflammatory Diseases, Departments of Surgery, Microbiology and Immunology, Baltimore, MD, USA
| | - Ram Lakhan
- University of Maryland School of Medicine, Center for Vascular and Inflammatory Diseases, Departments of Surgery, Microbiology and Immunology, Baltimore, MD, USA
| | - Bing Ma
- University of Maryland School of Medicine, Institute for Genome Sciences and Department of Microbiology & Immunology, Baltimore, MD, USA
| | - Emma Silverman
- University of Maryland School of Medicine, Center for Vascular and Inflammatory Diseases, Departments of Surgery, Microbiology and Immunology, Baltimore, MD, USA
| | - Zachariah L. Lee
- University of Maryland School of Medicine, Center for Vascular and Inflammatory Diseases, Departments of Surgery, Microbiology and Immunology, Baltimore, MD, USA
| | - Jonathan S. Bromberg
- University of Maryland School of Medicine, Center for Vascular and Inflammatory Diseases, Departments of Surgery, Microbiology and Immunology, Baltimore, MD, USA
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14
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Kindgren E, Ludvigsson J. Infections and antibiotics during fetal life and childhood and their relationship to juvenile idiopathic arthritis: a prospective cohort study. Pediatr Rheumatol Online J 2021; 19:145. [PMID: 34530851 PMCID: PMC8447683 DOI: 10.1186/s12969-021-00611-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/09/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The aetiology of juvenile idiopathic arthritis (JIA) is poorly understood. It has been shown that use of antibiotics is associated with JIA. However, whether the association is due to increased occurrence of infection in these individuals is unknown. The purpose of this investigation was to measure the association between number of infections and use of antibiotics during childhood with development of JIA. METHODS In ABIS (All Babies in Southeast Sweden) a population-based prospective birth cohort of 17,055 children, data were collected on infections and antibiotic exposure during pregnancy and childhood. 102 individuals with JIA were identified. Multivariable logistic regression analyses were performed, adjusting for confounding factors. RESULTS Exposure to antibiotics during the periods 1-12 months, 1-3 years and 5-8 years was significantly associated with increased risk for JIA. The odds of developing JIA were three times higher in those exposed to antibiotics during the first 3 years of life compared with those not exposed (aOR 3.17; 95% CI 1.11-9.03, p = 0.031), and more than twice as high in those exposed to antibiotics during the first 5 years of life compared with those not exposed (aOR 2.18; 95% CI 1.36-3.50, p = 0.001). The odds of developing JIA were 78% higher in those exposed to antibiotics during the first 8 years of life compared with those not exposed (aOR 1.78; 95% CI 1.15-2.73, p = 0.009). Occurrence of infection during fetal life or childhood showed no significant association with the risk of developing JIA, after confounder adjustment. The cumulative number of courses of antibiotics was significantly higher during childhood for the individuals who developed JIA (p < 0.001). Penicillins were more frequently used than non-penicillins, but both had an equal effect on the risk of developing JIA. CONCLUSIONS Exposure to antibiotics early in life is associated with later onset of JIA in a large birth cohort from the general population. The relationship was dose dependent. These results suggest that further, more restrictive, antibiotic policies during the first years of life would be advisable.
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Affiliation(s)
- Erik Kindgren
- Department of Pediatrics, Skaraborg Hospital Skövde, SE-541 85, Skövde, Sweden. .,Division of Pediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Johnny Ludvigsson
- grid.5640.70000 0001 2162 9922Division of Pediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Crown Princess Victoria Children’s Hospital, Linköping, Sweden
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15
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Chu XJ, Cao NW, Zhou HY, Meng X, Guo B, Zhang HY, Li BZ. The oral and gut microbiome in rheumatoid arthritis patients: a systematic review. Rheumatology (Oxford) 2021; 60:1054-1066. [PMID: 33450018 DOI: 10.1093/rheumatology/keaa835] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/12/2020] [Accepted: 11/19/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Recently, researchers have proposed a possible relationship between RA and the microbiome of the oral cavity and gut. However, this relation has not been systematically established. Herein, we conducted a comprehensive review of the pertinent literature to describe this possible association. METHODS We systematically performed searches in databases, namely EMBASE, the Cochrane Library, and PubMed, from inception to 7 June 2020 to identify case-control studies that compared the oral and gut microbiome in adult RA patients with those of controls. The primary outcome was specific bacterial changes between RA and controls. The secondary outcome was microbial diversity changes between RA and controls. RESULTS In total, 26 articles were considered eligible for inclusion and reported some differences. Therein, ≥3 articles reported decreased Faecalibacterium in the gut of early-RA (ERA)/RA patients compared with healthy controls (HCs). Also, ≥3 articles reported decreased Streptococcus and Haemophilus and increased Prevotella in the oral cavity of ERA/RA patients compared with HCs. In addition, some Prevotella species, including P. histicola and P. oulorum, showed increased trends in RA patients' oral cavity, compared with HCs. The α-diversity of the microbiome was either increased or not changed in the oral cavity of RA patients, but it was more commonly either decreased or not changed in the gut of RA patients. CONCLUSIONS In this systematic review, we identified the microbiome associated with RA patients in comparison with controls. More research is needed in the future to find the deep relationship between RA and the microbiome.
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Affiliation(s)
- Xiu-Jie Chu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Hefei, China
| | - Nv-Wei Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Hefei, China
| | - Hao-Yue Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Hefei, China
| | - Xiang Meng
- School of Stomatology, Anhui Medical University, Anhui Hefei, China
| | - Biao Guo
- Department of Human Resource, The Second Affiliated Hospital of Anhui Medical University, Anhui Hefei, China
| | - Hai-Yan Zhang
- Department of health inspection and quarantine, School of Public Health, Anhui Medical University, Anhui Hefei, China
| | - Bao-Zhu Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Hefei, China
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16
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Etiologies of Rheumatoid Arthritis: Update on Mucosal, Genetic, and Cellular Pathogenesis. Curr Rheumatol Rep 2021; 23:21. [PMID: 33646410 PMCID: PMC7919619 DOI: 10.1007/s11926-021-00993-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 12/11/2022]
Abstract
Purpose of Review Over the last few years, the scientific community has made significant progress in understanding the etiology of rheumatoid arthritis (RA). In this review, we summarize those key findings and trends. Recent Findings New data strongly implicates respiratory exposures, obesity, diet and microbiome, genetics, and their interactions in the etiology of RA. Furthermore, anti-posttranslationally modified protein antibodies (AMPAs) and abnormal glycosylation may be additional biomarkers for RA. Finally, functional genomics techniques implicate loss of certain macrophage populations and proliferation of synovial fibroblasts in RA. Summary These findings support the notion that RA originates at mucosal sites, augmented by genetic predisposition, and mediated by certain cell types including macrophages and fibroblasts. Weight loss, physical activity, and diet are additional modifiable factors beyond smoking cessation that can reduce risk of RA. Future epidemiologic and translational studies leveraging multi-omics approaches will help map the precise sequence of events in RA pathogenesis.
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17
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Yuan J, Zhang C, Sparks JA, Malspeis S, Tsoi KKF, Kim JH, Fisher BA, Gao F, Sumerlin T, Liu Y, Liu Y, Pan Y, He Y, Sung JJ. Regular use of proton pump inhibitor and risk of rheumatoid arthritis in women: a prospective cohort study. Aliment Pharmacol Ther 2020; 52:449-458. [PMID: 32598046 PMCID: PMC7406413 DOI: 10.1111/apt.15834] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/20/2020] [Accepted: 05/13/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Proton pump inhibitors (PPIs) have a significant impact on the gut microbiome, which in turn, might increase the risk of rheumatoid arthritis (RA). AIM To evaluate regular use of PPIs and risk of RA. METHODS This is a prospective analysis of the US nurses who reported PPI use data, and were free of RA from the Nurses' Health Study (NHS 2002-2014) and NHS II (2003-2015). The exposure was regular use of PPI in the past 2 years, which was repeatedly evaluated in biennial surveys. RA was confirmed by the 1987 or 2010 American College of Rheumatology criteria. We estimated the hazard ratios (HRs) and confidence interval (CIs) with time-dependent Cox regression adjusting for potential confounders. RESULTS We documented 421 cases of RA over 1 753 879 person-years of follow-up. Regular PPI users had a 44% higher risk of RA as compared with non-regular users (adjusted HR = 1.44; 95%CI, 1.10-1.89). The risk of RA increased with the total duration of PPI use (P-trend = 0.008). Compared with non-regular users, the adjusted HRs were 1.22 (95%CI, 0.93-1.62) for women with >0 to 4 years' use and 1.73 (95% CI, 1.14 to 2.61) for >4 years' use. CONCLUSIONS Regular use of PPI was associated with increased risk of RA in women, with a higher risk observed in individuals with a longer duration of PPI use. Due to the observational study design, large prospective trials are still required to confirm our finding.
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Affiliation(s)
- Jinqiu Yuan
- Clinical Research Center, The Seventh Affiliated Hospital, Sun
Yat-sen University, Shenzhen, Guangdong, 518107, China; Scientific Research Center, The Seventh
Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China,Center for Digestive Disease, The Seventh Affiliated Hospital, Sun
Yat-sen University, Shenzhen, Guangdong, 518107, China
| | - Changhua Zhang
- Center for Digestive Disease, The Seventh Affiliated Hospital, Sun
Yat-sen University, Shenzhen, Guangdong, 518107, China
| | - Jeffrey A. Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and
Women’s Hospital, 60 Fenwood Road, #6016U, Boston, MA 02115, USA,Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Susan Malspeis
- Division of Rheumatology, Inflammation, and Immunity, Brigham and
Women’s Hospital, 60 Fenwood Road, #6016U, Boston, MA 02115, USA
| | - Kelvin Kam-fai Tsoi
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese
University of Hong Kong, Shatin, Hong Kong.,Jockey Club School of Public Health and Primary Care, The Chinese
University of Hong Kong, Shatin, Hong Kong
| | - Jean H. Kim
- Jockey Club School of Public Health and Primary Care, The Chinese
University of Hong Kong, Shatin, Hong Kong
| | - Benjamin A. Fisher
- Rheumatology Research Group, Institute of Inflammation and Ageing,
University of Birmingham, Birmingham, UK
| | - Fang Gao
- Birmingham Acute Care Research Group, Institute of Inflammation and
Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Tim Sumerlin
- Jockey Club School of Public Health and Primary Care, The Chinese
University of Hong Kong, Shatin, Hong Kong
| | - Yan Liu
- Precision Medicine Center. Scientific Research Center, The
Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
| | - Yuxing Liu
- Department of Pharmacy, The Seventh Affiliated Hospital, Sun
Yat-sen University, Shenzhen, Guangdong, 518107, China
| | - Yihang Pan
- Precision Medicine Center. Scientific Research Center, The
Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China,Corresponding Authors: Yihang Pan, PhD. Precision Medicine
Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, 518107,
China (). Yulong He, MD. Center for Digestive Disease,
The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
()
| | - Yulong He
- Center for Digestive Disease, The Seventh Affiliated Hospital, Sun
Yat-sen University, Shenzhen, Guangdong, 518107, China,Corresponding Authors: Yihang Pan, PhD. Precision Medicine
Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, 518107,
China (). Yulong He, MD. Center for Digestive Disease,
The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
()
| | - Joseph J.Y. Sung
- Institute of Digestive Disease, The Chinese University of Hong
Kong, Shatin, Hong Kong
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18
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Hughes KR, Schofield Z, Dalby MJ, Caim S, Chalklen L, Bernuzzi F, Alcon-Giner C, Le Gall G, Watson AJM, Hall LJ. The early life microbiota protects neonatal mice from pathological small intestinal epithelial cell shedding. FASEB J 2020; 34:7075-7088. [PMID: 32253791 PMCID: PMC7610993 DOI: 10.1096/fj.202000042r] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 12/16/2022]
Abstract
The early life gut microbiota plays a crucial role in regulating and maintaining the intestinal barrier, with disturbances in these communities linked to dysregulated renewal and replenishment of intestinal epithelial cells. Here we sought to determine pathological cell shedding outcomes throughout the postnatal developmental period, and which host and microbial factors mediate these responses. Surprisingly, neonatal mice (Day 14 and 21) were highly refractory to induction of cell shedding after intraperitoneal administration of liposaccharide (LPS), with Day 29 mice showing strong pathological responses, more similar to those observed in adult mice. These differential responses were not linked to defects in the cellular mechanisms and pathways known to regulate cell shedding responses. When we profiled microbiota and metabolites, we observed significant alterations. Neonatal mice had high relative abundances of Streptococcus, Escherichia, and Enterococcus and increased primary bile acids. In contrast, older mice were dominated by Candidatus Arthromitus, Alistipes, and Lachnoclostridium, and had increased concentrations of SCFAs and methyamines. Antibiotic treatment of neonates restored LPS-induced small intestinal cell shedding, whereas adult fecal microbiota transplant alone had no effect. Our findings further support the importance of the early life window for microbiota-epithelial interactions in the presence of inflammatory stimuli and highlights areas for further investigation.
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Affiliation(s)
- Kevin R Hughes
- Gut Microbes & Health, Quadram Institute Bioscience, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Zoe Schofield
- Gut Microbes & Health, Quadram Institute Bioscience, Norwich, UK
| | - Matthew J Dalby
- Gut Microbes & Health, Quadram Institute Bioscience, Norwich, UK
| | - Shabhonam Caim
- Gut Microbes & Health, Quadram Institute Bioscience, Norwich, UK
| | - Lisa Chalklen
- Gut Microbes & Health, Quadram Institute Bioscience, Norwich, UK
| | | | | | - Gwénaëlle Le Gall
- Gut Microbes & Health, Quadram Institute Bioscience, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Lindsay J Hall
- Gut Microbes & Health, Quadram Institute Bioscience, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
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19
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Meng T, Zhang S, Wang D, Zhang H, Song Z, Li S, Chen M, Tang C. Association between antibiotic use and the risk of rheumatoid arthritis: A protocol for a systematic review. Medicine (Baltimore) 2020; 99:e19155. [PMID: 32118718 PMCID: PMC7478554 DOI: 10.1097/md.0000000000019155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The potential association between antibiotic use and the risk of rheumatoid arthritis (RA) has drawn significant attention from clinicians and researchers in recent years due to the wild usage of antibiotic. This study aimed to perform a systematic review and meta-analysis of the literature to determine if antibiotic use is associated with an increased risk of RA, so as to provide an important reference for clinical decision-making. METHODS Case-control and nest case-control studies of assessing whether antibiotic use is associated with the onset of RA will be identified in searches of 4 databases from their inception to August 2019. All data were assessed and extracted by 2 authors independently. The Newcastle-Ottawa scale was used to assess the quality of the selected studies. Manager Software 5.3 from Cochrane Collaboration (London, UK) and Stata 15.1 (Stata Corp, College Station, TX) will be used to conduct meta-analysis, determining pooled odds ratios and evaluating heterogeneity between studies. RESULT The results of this systemic review and meta-analysis will be submitted to a recognized journal for publication. CONCLUSION This systemic review and meta-analysis will determine if antibiotic use is associated with an increased risk of RA. We hope this study can make a definitive conclusion for the association.
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Affiliation(s)
- Tingting Meng
- Faculty of Chinese Medicine, Macau University of Science and Technology, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau
| | - Shibin Zhang
- Faculty of Chinese Medicine, Macau University of Science and Technology, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau
| | - Dawei Wang
- Shunde Hospital of Guangzhou University of Chinese Medicine, Shunde District Hospital of Chinese Medicine of Foshan City, Foshan, Guangdong
| | - Haijun Zhang
- Department of Orthopaedics, Gansu Second Provincial People's Hospital
| | - Zhongyang Song
- Clinical Medical College of Traditional Chinese Medicine, Gansu University of Chinese medicine, Lanzhou, Gansu
| | - Shengdong Li
- Department of Rheumatology, The Second Hospital of Yinzhou, Ninbo Zhejiang, China
| | - Min Chen
- Faculty of Chinese Medicine, Macau University of Science and Technology, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau
- The State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau
| | - Chunzhi Tang
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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20
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Arvonen M, Vänni P, Sarangi AN, V Tejesvi M, Vähäsalo P, Aggarwal A, Stoll ML. Microbial orchestra in juvenile idiopathic arthritis: Sounds of disarray? Immunol Rev 2019; 294:9-26. [DOI: 10.1111/imr.12826] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/07/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Miika Arvonen
- Department of Pediatrics Kuopio University HospitalUniversity of Eastern Finland Kuopio Finland
- PEDEGO Research Unit Faculty of Medicine University of Oulu Oulu Finland
| | - Petri Vänni
- PEDEGO Research Unit Faculty of Medicine University of Oulu Oulu Finland
- Genobiomics LLC Oulu Finland
| | - Aditya Narayan Sarangi
- Biomedical Informatics Center Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Mysore V Tejesvi
- Genobiomics LLC Oulu Finland
- Department of Ecology and Genetics University of Oulu Oulu Finland
| | - Paula Vähäsalo
- PEDEGO Research Unit Faculty of Medicine University of Oulu Oulu Finland
- Department of Children and Adolescents Oulu University Hospital Oulu Finland
- Medical Research Center Oulu Oulu Finland
| | - Amita Aggarwal
- Department of Clinical Immunology & Rheumatology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Matthew L Stoll
- Department of Pediatrics University of Alabama at Birmingham Birmingham AL USA
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21
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Kim SY, Chanyang M, Oh DJ, Choi HG. Association between depression and rheumatoid arthritis: two longitudinal follow-up studies using a national sample cohort. Rheumatology (Oxford) 2019; 59:1889-1897. [DOI: 10.1093/rheumatology/kez559] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/16/2019] [Indexed: 01/06/2023] Open
Abstract
Abstract
Objective
To investigate the bidirectional relation between RA and depression.
Methods
Data from the Korean Health Insurance Review and Assessment Service – National Sample Cohort from 2002 to 2013 were analysed. Patients ≥20 years of age were included. Study I was conducted with 38 087 depression patients and 152 348 matched control participants. Study II was conducted with 7385 RA patients and 29 540 matched control participants. Stratified Cox proportional hazards models were used to analyse the hazard ratios (HRs) for depression and RA (study I) and for RA and depression (study II). The data were adjusted by the Charlson comorbidity index; rheumatic disease was excluded. Subgroups were also analysed according to age and sex.
Results
A total of 0.7% (1260/38 087) of the depression group and 0.6% (883/152 348) of the control I group had RA (P = 0.02). The HR for RA in the depression group was not significantly higher than that in control I group. In study II, 5.5% (408/7385) of the RA group and 4.3% (1246/29 540) of the control II group presented with depression (P < 0.001). The RA patients showed an adjusted depression HR that was 1.20 times higher (95% CI 1.07, 1.34; P = 0.002) than that of the control group. The >30-years-old and women subgroups of RA patients showed higher depression HRs than the control subgroups.
Conclusion
RA increased the risk of depression; however, depression did not increase the risk of RA in the Korean adult population.
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Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Min Chanyang
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Dong Jun Oh
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyo Geun Choi
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea
- Department of Otorhinolaryngology–Head and Neck Surgery, Hallym University College of Medicine, Anyang, Korea
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