Taizhou Hospital, Shanghai University of Traditional Chinese Medicine, Taizhou, China.
Medicine (Baltimore). 2023 Sep 15;102(37):e35088. doi: 10.1097/MD.0000000000035088.
A large body of research has investigated the use of statins in rheumatoid arthritis (RA); however, the therapeutic effects of statins remain uncertain. Thus, we designed a systematic review and meta-analysis to evaluate the role of statins in patients with RA.
Databases searched to detect clinical randomized controlled trials or clinical controlled trials on the interaction between statins and RA before January 2020 included PubMed, Web of Sciences, Embase, Cochrane Library, CNKI, Wan Fang Database. Efficacy was measured by Disease Activity Score in 28 Joints (DAS28), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), tenderness of the joint (TJ), swelling of the joint (SJ), and interleukin-6. The level of blood lipid was also evaluated. STATA 12.0 was used for the meta-analysis. The Cochrane method was used for quality assessment. Heterogeneity was considered to determine fixed effects or random effects models.
Nineteen clinical trials with a total of 22,906 subjects were included in the meta-analysis. Sixteen studies reported a change in DAS28 after statin treatment. The pooled analysis showed that statins reduced DAS28 in RA patients. Change in ESR after statin treatment was reported in 9 studies. The summary analysis showed that statins lowered ESR in RA patients. Twelve studies reported a change in CRP after statin treatment. The results of the entire analysis showed that statins lowered CRP in RA patients. Seven studies reported a change in TJ after statin treatment. The combined analysis showed that statins reduced TJ at RA patients. Six studies reported changes in IL6 after statin therapy. The results showed that statins failed to reduce IL6 in RA patients. Seven studies reported changes in SJ after statin therapy, which showed that statins failed to reduce SJ in RA patients. We also found that statins can reduce blood lipid levels in RA patients.
In conclusion, statins were able to reduce DAS28, ESR, CRP, TJ, and blood lipids. It indicated that stains can benefit patients with RA by inhibiting the expression of inflammatory factors and reducing the levels of lipids in the blood. Our study may offer a new perspective on the treatment of RA and provide research ideas for future larger multi-center clinical trials.
大量研究调查了他汀类药物在类风湿关节炎（RA）中的应用；然而，他汀类药物的治疗效果仍不确定。因此，我们设计了一项系统评价和荟萃分析，以评估他汀类药物在 RA 患者中的作用。
我们检索了 2020 年 1 月前有关他汀类药物与 RA 相互作用的临床随机对照试验或临床对照试验的数据库，包括 PubMed、Web of Sciences、Embase、Cochrane Library、CNKI、万方数据库。采用疾病活动评分 28 关节（DAS28）、红细胞沉降率（ESR）、C 反应蛋白（CRP）、关节压痛（TJ）、关节肿胀（SJ）和白细胞介素-6 来衡量疗效。还评估了血脂水平。采用 STATA 12.0 进行荟萃分析。采用 Cochrane 方法进行质量评估。考虑异质性以确定固定效应或随机效应模型。
荟萃分析共纳入 19 项临床试验，共 22906 例受试者。16 项研究报告了他汀类药物治疗后 DAS28 的变化。汇总分析显示，他汀类药物可降低 RA 患者的 DAS28。9 项研究报告了他汀类药物治疗后 ESR 的变化。汇总分析显示，他汀类药物可降低 RA 患者的 ESR。12 项研究报告了他汀类药物治疗后 CRP 的变化。全分析结果显示，他汀类药物可降低 RA 患者的 CRP。7 项研究报告了他汀类药物治疗后 TJ 的变化。联合分析显示，他汀类药物可降低 RA 患者的 TJ。6 项研究报告了他汀类药物治疗后 IL6 的变化。结果表明，他汀类药物不能降低 RA 患者的 IL6。7 项研究报告了他汀类药物治疗后 SJ 的变化，表明他汀类药物不能降低 RA 患者的 SJ。我们还发现，他汀类药物可以降低 RA 患者的血脂水平。
总之，他汀类药物可以降低 DAS28、ESR、CRP、TJ 和血脂。这表明他汀类药物通过抑制炎症因子的表达和降低血液中的脂质水平，可以使 RA 患者受益。我们的研究可能为 RA 的治疗提供新的视角，并为未来更大规模的多中心临床试验提供研究思路。
