Jick S S, Choi H, Li L, McInnes I B, Sattar N
Boston Collaborative Drug Surveillance Program, Boston University School of Medicine, Lexington, Massachusetts 02421, USA.
Ann Rheum Dis. 2009 Apr;68(4):546-51. doi: 10.1136/ard.2008.091967. Epub 2008 Jul 28.
To evaluate whether statins are associated with a protective effect on the development of rheumatoid arthritis (RA).
A nested case-control study was conducted using data from the General Practice Research Database. A study population consisting of three groups of subjects aged 40-89 years was identified: (1) patients exposed to a statin or other lipid-lowering agent (LLA); (2) patients with a diagnosis of hyperlipidaemia in the absence of lipid-lowering drug treatment and (3) a random sample of 25 000 individuals with no diagnosis of hyperlipidaemia nor a prescription for a LLA. From this population incident cases of RA and up to four controls for each case were identified, matched on age, sex, general practice, number of years of recorded history in the database and index date. The independent effects of hyperlipidaemia and statins on the development of RA were evaluated using conditional logistic regression.
313 cases of RA and 1252 matched controls were identified. Compared with patients with untreated hyperlipidaemia, or hyperlipidaemia treated with LLA other than statins, the adjusted odds ratio for patients with no hyperlipidaemia was 0.68 (95% CI 0.50 to 0.91). When those with hyperlipidaemia who received statins were compared with those with hyperlipidaemia who did not use statins (ie, untreated hyperlipidaemia patients or those treated with non-statin LLA) the OR was 0.59 (95% CI 0.37 to 0.96).
These data provide evidence to support the hypothesis that statins may be protective against the development of RA in patients with hyperlipidaemia.
评估他汀类药物是否对类风湿关节炎（RA）的发展具有保护作用。
利用全科医疗研究数据库的数据进行巢式病例对照研究。确定了由三组年龄在40 - 89岁的受试者组成的研究人群：（1）暴露于他汀类药物或其他降脂药物（LLA）的患者；（2）诊断为高脂血症但未接受降脂药物治疗的患者；（3）从25000名未诊断为高脂血症且未开具LLA处方的个体中随机抽取的样本。从该人群中确定RA的发病病例，并为每个病例匹配多达4名对照，匹配因素包括年龄、性别、全科医疗、数据库中记录病史的年限和索引日期。使用条件逻辑回归评估高脂血症和他汀类药物对RA发展的独立影响。
确定了313例RA病例和1252例匹配对照。与未治疗的高脂血症患者或用非他汀类LLA治疗的高脂血症患者相比，无高脂血症患者的调整优势比为0.68（95%可信区间0.50至0.91）。将接受他汀类药物治疗的高脂血症患者与未使用他汀类药物的高脂血症患者（即未治疗的高脂血症患者或接受非他汀类LLA治疗的患者）进行比较时，优势比为0.59（95%可信区间0.37至0.96）。
这些数据提供了证据支持他汀类药物可能对高脂血症患者的RA发展具有保护作用这一假设。
