Antibiotics are important, lifesaving medications that help treat bacterial infections. But these prescription drugs may pose problems with autoimmune conditions like rheumatoid arthritis (RA).

The exact cause of RA isn’t known, but researchers believe that a combination of certain risk factors and triggers may play a role. These factors may include:

  • your genetics
  • your sex
  • infections
  • tobacco use

Researchers have identified another possible trigger of RA: antibiotic use. While more research is needed on the exact link, emerging studies are exploring the possibility that antibiotics may be a risk factor for developing RA later in life.

While antibiotics may sometimes be necessary, researchers have started looking at ways these medications might negatively affect the body. There’s even some research to suggest that antibiotics could trigger RA.

According to a 2019 case-control study, a population assessment of 22,677 people with RA found such a link. Here, researchers found that people who took antibiotics were 60% more likely to develop RA than those who didn’t take this medication.

They also found that the timing of the antibiotic use may have played a role, with most people in the study developing RA within 1–2 years.

A 2020 study supports these findings. Participants who took antibiotics were more likely to develop RA, especially if they took more than 10 antibiotics within 5 years. Antibiotic use early in life was also linked with an increased risk.

Antibiotics and the gut microbe

In recent years, researchers have established strong links between your gut microbiome and your overall health. This includes your immune system.

As one 2020 review explains, scientists have even linked gut dysbiosis — which is an imbalance of healthy bacteria in your microbiota — with an increased risk of developing an autoimmune condition. This is because antibiotics can kill both “bad” and “good” gut microbes.

Researchers behind the 2019 case-control study also hypothesize that a disrupted gut microbiome could be one explanation for the increased incidence of RA from antibiotic use. However, there are other factors to consider.

Antibiotics and respiratory infections

Another possible link between antibiotics and RA may not directly involve the medication. Instead, it may be down to the condition it’s treating.

Respiratory infections are just one example of this possible link. The same 2019 case-control study found that most people who got a diagnosis of RA after taking antibiotics received treatment for respiratory infections.

Urinary tract infections (UTIs) were another possible link.

Antibiotics and periodontal disease

Oral infections may also factor in. Gum disease, or periodontal disease, is one established risk factor for RA, with severe cases needing antibiotic treatment.

Research published in a 2023 study found that bacteria may enter the bloodstream as a result of periodontal disease and could, in fact, trigger RA activity.

In those who take antibiotics for this type of infection, however, it’s unclear whether the cause of RA is the medication or the bacteria from the gum disease. People who have both RA and periodontal disease tend to have worse arthritis symptoms, according to the 2023 study.

RA flare-ups are when symptoms worsen due to triggers. Some known triggers of flare-ups include stress, infections, and smoke exposure. In other cases though, the exact cause may not be known.

It’s also not clear whether antibiotics definitively lead to flare-ups in those who already have RA. That said, some research does suggest that antibiotics’ ability to disrupt your gut microbiome could lead to increased autoimmune disease activity.

There are hundreds of different types of antibiotics, and researchers are just beginning to investigate which might be associated with RA flare-ups.

Amoxicillin and rheumatoid arthritis

Amoxicillin is a common type of penicillin. It can treat respiratory infections, skin infections, and UTIs. Penicillins are associated with RA flare-ups in some people, though more research is needed to confirm the link.

Ciprofloxacin and rheumatoid arthritis

Ciprofloxacin is a broad-spectrum antibiotic belonging to a class called fluoroquinolones. While doctors primarily prescribe it for UTIs and respiratory infections, ciprofloxacin is not as common as other antibiotics due to its serious side effects. Quinolones are also associated with RA flare-ups.

Clindamycin and rheumatoid arthritis

The 2019 case-control study found that clindamycin had the highest odds of RA development compared with other types of antibiotics. But it’s not clear if this has to do with the antibiotic itself or if people simply take this medication more than others.

If you have RA or are concerned about your individual risk factors for developing this autoimmune condition, it’s important to discuss possible triggers with a doctor. This includes asking key questions involving antibiotic use.

Can antibiotics cause joint inflammation?

While this certainly isn’t the case for everyone, antibiotics may disrupt your gut microbiome and increase your chance of RA flare-ups. In turn, this may lead to an increase in RA symptoms, such as joint pain, inflammation, and stiffness.

Can antibiotics trigger other autoimmune conditions?

Recent research suggests links between antibiotics and other autoimmune conditions. One 2020 review, for example, discusses possible links between gut dysbiosis from antibiotics and an increased risk of type 1 diabetes and inflammatory bowel disease.

However, the authors also note that some people with these types of autoimmune conditions have improved symptoms after taking antibiotics. This highlights the challenges of establishing links between antibiotic use and disease development.

The exact cause of RA remains unknown, as is the case with other autoimmune conditions. While researchers are yet to prove any sort of cause-and-effect link between antibiotics and RA, the current research suggests that antibiotics could be a potential trigger for this condition.

If you take antibiotics and have RA, or if you’re concerned about your risk factors for developing RA in the future, consider speaking with a doctor. They can help determine the benefits versus risks of taking antibiotics, and they can also help you evaluate other risk factors for disease development or activity.