Juvenile idiopathic arthritis in relation to perinatal and maternal characteristics: a case control study

Abstract

BackgroundExisting data on associations between maternal and early childhood exposures and juvenile idiopathic arthritis (JIA) risk is scant and inconsistent with previous studies showing potential role for prematurity, number of siblings and infections. We explored JIA and International League of Associations for Rheumatology (ILAR) JIA categories in relation to selected infant (birthweight, size-for-gestational-age, gestational age), and maternal (parity, delivery type, prior fetal loss) characteristics that may be markers for exposures related to two pathways (hygiene hypothesis, microchimerism) potentially associated with autoimmune disorder occurrence.MethodsA case–control analysis with 1,234 JIA cases and 5,993 birth year-matched controls was conducted. Exposure information was obtained from WA state birth certificates. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for associations with maternal and early life exposures for JIA and JIA categories.ResultsGreater maternal parity was associated with a decreased OR for JIA (most marked for persistent oligoarticular JIA, OR 0.32, 95% CI 0.15; 0.71, p for trend = 0.0001). Prior fetal loss (except for oligoarticular JIA) was associated with an increased OR for JIA. Prematurity was associated with increased risk of enthesitis related arthritis (OR 1.9, 95% CI: 1.3–2.9) and rheumatoid factor positive polyarticular JIA (OR 2.2, 95% CI: 1.0–4.8).ConclusionsWe observed associations of selected maternal factors with JIA, some of which varied across JIA categories. The findings of decreased ORs for JIA in relation to greater maternal parity may be consistent with the hygiene and microchimerism hypotheses. Future studies with biomarkers relevant to these hypotheses will help elucidate any associations.

Microbial orchestra in juvenile idiopathic arthritis: Sounds of disarray?

“…The findings of this study were supported by a Swedish study of 3334 JIA cases compared to 13,336 of controls, which likewise reported higher rates of being born by CS among children with JIA compared to controls (OR 1.1, 95% CI 1.0 to 1.3). Finally, a Northern American study of 1234 subjects with JIA and 5,993 controls found a modest, non‐statistically significant increased risk of JIA associated with CS . Both the Swedish and Northern American studies failed to take into account whether or not the CS was elective.…”

“…Three registry studies have investigated the association between mode of delivery and future risk of JIA. In a large Danish epidemiological study of 1380 children with JIA and 789 189 controls, after adjustment for multiple potential confounding factors (gestational age, sex, birth weight, maternal age, maternal smoking during pregnancy, and complications during pregnancy), children delivered by cesarean section (CS) had an increased risk of JIA, with a hazard ratio of 1.25 (95% CI 1.04 − 1.51) compared to controls.…”

“…In addition, in preterm vs term infants a reduced abundance of Bacteroides (7% vs 19), Bifidobacterium (3% vs 15%), and Streptococcus (2% vs 9%) was observed. Interestingly prematurity is reported to be a risk factor for ERA (OR 1.9, 95% CI: 1.3‐2.9) and rheumatoid factor (RF)‐positive polyarticular JIA (OR 2.2, 95% CI: 1.0‐4.8) …”

“…Three registry studies [15][16][17] have investigated the association between mode of delivery and future risk of JIA. In a large Danish epidemiological study 16 17 Both the Swedish and Northern American studies failed to take into account whether or not the CS was elective. This may be an important limitation due to possible differences in microbiota colonization between the two groups.…”

Adrenal Insufficiency in Children with Juvenile Idiopathic Arthritis (JIA) Treated with Prednisolone

“…It is one of the most common chronic diseases of childhood, with the annual incidence and prevalence rates ranging from 1.6 to 23 per 100,000 and 3.8 to 400 per 100,000, respectively (2). The exact etiology of JIA is unclear; however, both genetic and environmental factors are thought to play a role in the pathophysiology of the disease (3).…”