Department of rheumatology, Henri-Mondor hospital, AP-HP, 94010 Créteil cedex, France.
MRC lifecourse epidemiology unit, Southampton general hospital, Southampton SO16 6YD, UK.
Joint Bone Spine. 2018 Oct;85(5):609-614. doi: 10.1016/j.jbspin.2017.09.014. Epub 2017 Oct 14.
Epidemiological and experimental studies have suggested that lipid disorders might be involved in the pathophysiology of knee osteoarthritis (OA). Studies assessing the effect of statins on knee OA progression have shown conflicting results. We investigated the impact of statin use on radiological progression in patients with radiological and symptomatic knee OA.
In total, 336 patients from the placebo arm of SEKOIA trial completed the 3-year follow-up and were included in this post-hoc analysis. Statin use was recorded at baseline interview. Minimal medial tibiofemoral joint space was measured on plain radiographs by an automated method at baseline and then annually. Radiologic progression was defined as joint space narrowing≥0.5mm over 3 years.
Overall, 71 patients were statin users (21.1%). They had a higher BMI (31.1±5.3 vs. 29.3±5.2kg/m, P=0.008), a higher sum of metabolic factors (≥3 factors: 43.7% vs 7.2%; P for trend<0.001) and a higher rate of radiological progression (49.3% vs. 32.1%, P=0.007) as compared to statin non-users. The significant association between radiological progression and statin use was independent of age, gender, WOMAC global score, disease duration, baseline joint space width, hypertension, type 2 diabetes, obesity (BMI>30kg/m) and cardiovascular diseases [relative risk 1.49 (95% CI: 1.10-2.02), P=0.010].
Among patients with knee OA, statin use was associated with radiological worsening over 3 years, regardless of other potential confounding factors (obesity, type 2 diabetes, hypertension, disease duration, symptom intensity and radiological severity).
流行病学和实验研究表明，脂代谢紊乱可能与膝骨关节炎（OA）的病理生理学有关。评估他汀类药物对膝骨关节炎进展影响的研究结果存在矛盾。我们研究了他汀类药物的使用对放射学和症状性膝骨关节炎患者放射学进展的影响。
总共纳入了 SEKOIA 试验安慰剂组中 336 名完成 3 年随访的患者，并对这些患者进行了此项事后分析。在基线访谈时记录了他汀类药物的使用情况。通过自动方法在基线和每年测量膝关节内侧胫骨股骨关节间隙的最小宽度。放射学进展定义为 3 年内关节间隙狭窄≥0.5mm。
总体而言，有 71 名患者使用了他汀类药物（21.1%）。与他汀类药物非使用者相比，他们的 BMI 更高（31.1±5.3 vs. 29.3±5.2kg/m，P=0.008），代谢因素的总和更高（≥3 个因素：43.7% vs 7.2%；P<0.001），放射学进展的发生率更高（49.3% vs. 32.1%，P=0.007）。放射学进展与他汀类药物使用之间的显著相关性独立于年龄、性别、WOMAC 总评分、疾病持续时间、基线关节间隙宽度、高血压、2 型糖尿病、肥胖（BMI>30kg/m）和心血管疾病[相对风险 1.49（95%CI：1.10-2.02），P=0.010]。
在膝骨关节炎患者中，他汀类药物的使用与 3 年内的放射学恶化有关，无论其他潜在的混杂因素（肥胖、2 型糖尿病、高血压、疾病持续时间、症状严重程度和放射学严重程度）如何。
