Could taking oral antibiotics increase your chances of developing rheumatoid arthritis years later? Evidence suggests that may be the case.

Research evidence suggests that people with rheumatoid arthritis have fewer species of microbes in their digestive tracts than healthy people. Knowing this possible link, scientists hypothesized that people who took oral antibiotics—which can kill off species of bacteria in the gut—would be more likely to develop rheumatoid arthritis.

Diet, medication, and infections can all affect the health and diversity of the gut microbiome and cause it to become unbalanced. Read more: Gut Microbiome Health and Diversity

To test this idea, the scientists examined the medical records of more than 22,000 people with rheumatoid arthritis and 90,000 healthy people. They found that people with rheumatoid arthritis were significantly more likely to have taken oral antibiotics at least one year before diagnosis. Overall, people who took antibiotics had a 60% greater chance of being diagnosed with RA.1

The connection between RA and antibiotics is still unclear
While this study strongly suggests antibiotic use and rheumatoid arthritis are linked, it does not prove that oral antibiotics lead to RA. For example, researchers note that the infection being treated with antibiotics, not the antibiotics themselves, may play a role. More research in this area is needed.

See Connections Between the Gut Microbiome and Arthritis


Anti-viral and anti-fungal medications are also associated with risk

In the same study, researchers found that people who took anti-viral and anti-fungal medications were also more likely to be later diagnosed with rheumatoid arthritis.

Like antibiotics, anti-viral and anti-fungal medications affect the gut microbiome, which is made up of tens of thousands of species of microbiota—bacteria, fungi, viruses, and other one-celled organisms—that live along the digestive tract, mostly in the intestines.

See The Science Behind Leaky Gut, the Gut Microbiome, and Arthritis

Antibiotics are sometimes necessary

Knowing that antibiotics are associated with an increased risk of developing RA, some people may want to avoid antibiotics altogether. However, it important to remember a few facts:

  • Oral antibiotics—as well as anti-viral and anti-fungal medications—are sometimes necessary to treat or prevent serious infections, which can become life-threatening.
  • The overall risk of being diagnosed with rheumatoid arthritis is 0.4% to 1.3%.2,3 Even with a 60% increase, the risk of getting rheumatoid arthritis is relatively low.
  • It’s possible to get rheumatoid arthritis even if you have never taken antibiotics. Many other factors, such as genetics, age, weight, and nicotine use, also play roles.

People who are prescribed antibiotics but who are hesitant to take them can ask their health care providers questions, such as, “What will happen if I don’t take this antibiotic? Is there another option?” Ask if a topical or injectable antibiotic, which has less impact on gut microbiome, is available. A health care provider can explain whether or not an oral antibiotic is necessary.

See Reduce the Risk of Arthritis by Improving the Microbiome


Maintaining a healthy gut microbiome

Avoiding unnecessary antibiotics is just one way to help maintain a diverse and healthy gut microbiome. Diet influences the gut microbiome, and eating a diet that emphasizes fruits and vegetables and limits processed foods may support gut health. Stopping smoking, getting regular exercise, and other lifestyle changes can also encourage a healthy gut microbiome.

Learn more

Improving the Gut Microbiome and Arthritis Symptoms with Diet

Foods for a Healthier Gut and Less Arthritis Pain


  • 1.Sultan AA, Mallen C, Muller S, et al. Antibiotic use and the risk of rheumatoid arthritis: a population-based case-control study. BMC Med. 2019;17(1):154. Published 2019 Aug 7. doi:10.1186/s12916-019-1394-6
  • 2.Silman AJ, Hochberg MC. Epidemiology of the rheumatic diseases. 2nd edition: Oxford University Press; 2001
  • 3.Sacks JJ, Luo YH, Helmick CG. Prevalence of specific types of arthritis and other rheumatic conditions in the ambulatory health care system in the United States, 2001-2005. Arthritis Care Res (Hoboken). 2010;62(4):460-4.