“Statins at high intensity may reduce the risk of hip and knee replacement. The effect may be RA specific,” Dr. Aliya Sarmanova of the University of Nottingham, U.K., and colleagues write in Rheumatology.1
Statins have anti-inflammatory effects, and there is some evidence linking them to reduced disease activity in patients with rheumatoid arthritis (RA), the authors note. Studies of statins and osteoarthritis (OA) have had more mixed results.
Using electronic health records from a UK primary care database, the authors matched more than 178,000 statin users to non-users by propensity score. Mean follow-up was 6.88 years for statin users and 6.25 years for non-users.
Statin-treatment intensity was classified based on potency of LDL-cholesterol reduction: low intensity (21–28%); medium (32–38%); or high (42–55%). About three-quarters of study participants were on medium-intensity treatment.
Statin use was not associated with knee joint replacement (KJR), hip joint replacement (HJR) or joint replacement due to OA. But statin users who had RA had a significantly reduced likelihood of joint replacement compared to non-statin-using RA patients (hazard ratio: 0.77).
Patients on high-intensity statins were at reduced risk of any joint replacement (HR, 0.86), joint replacement due to RA (HR, 0.10) and joint replacement for OA (HR 0.79).
There was a trend toward a dose-response effect for overall joint replacement and knee joint replacement.
Although the effect was small and may not be clinically significant, “at this early stage we believe that a statistical significance should not be ignored,” Dr. Sarmanova and her colleagues write.
“Given the limitations of this study, further well designed studies are still needed to examine the mechanism of statins in RA,” they add. “A randomized controlled trial to assess the efficacy and cost-effectiveness of different treatment regimens of statin with or without other anti-rheumatic drugs in people with RA and CVDs or at high risk of CVDs is also justified.”
The study had no commercial funding, and the researchers report no ties to manufacturers.
- Sarmanova A, Doherty M, Kuo C, et al. Statin use and risk of joint replacement due to osteoarthritis and rheumatoid arthritis: A propensity-score matched longitudinal cohort study. Rheumatology (Oxford). 2020 Feb 25. pii: keaa044. [Epub ahead of print]