Recent infections are associated with decreased risk of rheumatoid arthritis: a population-based case-control study.

OBJECTIVES: Do recent infections affect the risk of rheumatoid arthritis (RA)? METHODS: We used the population-based case-control study EIRA (N=6401) on incident RA and healthy controls, matched for sex, age, calendar period and area of residence. Gastroenteritis, urinary tract infection, genital infection, prostatitis, sinusitis, tonsillitis and pneumonia during the 2 years before inclusion in the study were investigated. Conditional logistic regression was used to calculate OR, adjusting for smoking and socioeconomic status. RESULTS: Infections in the gastrointestinal and urogenital tract before clinical onset were associated with a lowered risk of RA: gastroenteritis (OR=0.71 (95% CI 0.63 to 0.80)), urinary tract infections (OR=0.78 (95% CI 0.68 to 0.90)) and genital infections (OR=0.80 (95% CI 0.64 to 1.00)), while a non-significant association of similar magnitude was observed for the less common prostatitis (OR=0.64 (95% CI 0.38 to 1.08)). In contrast, no associations were observed for sinusitis, tonsillitis or pneumonia. CONCLUSIONS: Gastrointestinal and urogenital infections, but not respiratory infections, are associated with a significantly lowered risk of RA. The results indicate that infections in general do not affect the risk for RA, but that certain infections, hypothetically associated with changes in the gut microbiome, could diminish the risk.