Das Subham, Mohanty Manjushree, Padhan Prasanta
Department of Pharmacology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Department of Rheumatology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Indian J Pharmacol. 2015 Nov-Dec;47(6):605-9. doi: 10.4103/0253-7613.169585.
Rheumatoid arthritis (RA) is characterized by symmetric peripheral polyarthritis, inflammatory synovitis, and articular destruction. Statins, 3-hydroxy-3-methylglutaryl coenzyme A-reductase inhibitors, mediate significant vascular risk reduction in patients with coronary artery disease by promoting reduction in plasma levels of low-density-lipoprotein cholesterol. Extensive in vitro data, experimental studies and more recently few clinical trials have strongly suggested statins to possess an important role in RA mainly mediated by their anti-inflammatory and immunomodulatory properties. The objective of this study was to evaluate the effect of adjunct statin therapy in comparison to standard disease modifying antirheumatic drugs (DMARD) therapy in patients with RA.
In this observational study, diagnosed RA patients of age group between 40 and 60 years were selected as per the inclusion criteria from the rheumatology outdoor. From the selected patients, we identified two separate groups of patients. Group 1 included 30 patients of RA currently under DMARD therapy with adjunct statin medication. Group 2 included 30 patients of RA currently under DMARD therapy. Patients were followed up over 6 months. Standard parameters such as disease activity score (DAS28), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were recorded for comparing the outcome of RA in both groups.
Out of a total of 60 patients who took part in the study, significant beneficial role of adjunct statin medication was found in this study when prescribed along with conventional DMARDs in active RA patients. The mean DAS28, considered by far as the most important index of clinical disease activity in RA, was found to be significantly lower (P < 0.05) in the adjunct statin-treated group (group 1) than that of the conventional DMARD treated group (group 2) after 6 months of continuous therapy. Other two important biochemical markers of RA disease activity, that is, ESR and CRP were also found to be significantly lower (P < 0.05) in RA patients who were on adjunct statin medication (group 1) than in group 2 comprising RA patients only under conventional DMARDs therapy without statin medication.
The results suggest an adjunct and potentially beneficial role of statin therapy in active cases of RA, producing significant clinical and biochemical improvement.
类风湿关节炎（RA）的特征为对称性外周多关节炎、炎症性滑膜炎及关节破坏。他汀类药物，即3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂，通过促使低密度脂蛋白胆固醇血浆水平降低，显著降低冠心病患者的血管风险。大量体外数据、实验研究以及最近的一些临床试验均强烈提示，他汀类药物在RA中发挥重要作用，主要是通过其抗炎和免疫调节特性介导。本研究的目的是评估辅助他汀类药物治疗与标准改善病情抗风湿药物（DMARD）治疗相比，对RA患者的疗效。
在这项观察性研究中，根据纳入标准，从风湿病门诊选取年龄在40至60岁之间的确诊RA患者。从选定患者中，我们确定了两组不同的患者。第1组包括30例正在接受DMARD治疗并辅助使用他汀类药物的RA患者。第2组包括30例正在接受DMARD治疗的RA患者。对患者进行了6个月的随访。记录疾病活动评分（DAS28）、红细胞沉降率（ESR）和C反应蛋白（CRP）等标准参数，以比较两组RA的治疗结果。
在参与研究的60例患者中，本研究发现，在活动性RA患者中，辅助使用他汀类药物与传统DMARDs联合使用时具有显著的有益作用。在持续治疗6个月后，辅助使用他汀类药物治疗组（第1组）中，迄今为止被认为是RA临床疾病活动最重要指标的平均DAS28显著低于传统DMARD治疗组（第2组）（P<0.05）。RA疾病活动的另外两个重要生化指标，即ESR和CRP，在辅助使用他汀类药物的RA患者（第1组）中也显著低于仅接受传统DMARDs治疗而未使用他汀类药物的第2组RA患者（P<0.05）。
结果表明，他汀类药物治疗在活动性RA病例中具有辅助作用且可能有益，可带来显著的临床和生化改善。
