Use of statins is associated with an increased risk of rheumatoid arthritis
- H J I de Jong1,2,3,
- O H Klungel3,
- L van Dijk4,
- R J Vandebriel1,
- H G M Leufkens3,
- JW van der Laan5,
- J W Cohen Tervaert6,
- H van Loveren1,2
- 1Laboratory for Health Protection Research, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- 2Department of Toxicogenomics, Maastricht University Medical Centre, Maastricht, The Netherlands
- 3Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Faculty of Sciences, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- 4Pharmaceutical Care, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- 5Centre for Biological Medicines and Medical Technology, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- 6Division of Clinical and Experimental Immunology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Correspondence to O H Klungel, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, PO Box 80 082, 3508 TB Utrecht, The Netherlands; o.h.klungel{at}uu.nl.
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Contributors HJIDJ contributed to the design of the study, performed the data analysis and drafted the paper. OHK contributed to the design of the study, the data analysis and the interpretation of the results, and reviewed the manuscript. LVD provided the data, contributed to the interpretation of the results and reviewed the paper. RJV provided the background data for the study, contributed to the interpretation of the data and reviewed the paper. HGML, JWVDL and JWCTs were involved in initiating the project to which the study presented belongs, provided the background data for the study and reviewed the paper. HVL initiated and obtained the funding for the project to which the study presented belongs, contributed to the design of the study and the interpretation of the results, provided the background data, reviewed the paper and is the guarantor.
- Accepted 14 August 2011
- Published Online First 6 October 2011
Abstract
Objectives Statins offer significant cardiovascular benefits. Their use, however, influences immune regulation, which may potentially facilitate autoimmunity, eventually resulting in autoimmune diseases such as rheumatoid arthritis (RA).The authors studied whether statin use was associated with an increased risk of developing RA by conducting a case–control study using the Netherlands Information Network of General Practice database.
Methods The authors identified 508 patients aged 40 years or older with a first-time diagnosis of RA in the period 2001–2006. Each RA case was matched to five controls for age, sex and index date, which was selected 1 year before the first diagnosis of RA. Odds ratios for the first-time diagnosis of RA were verified by a referral to a rheumatologist and/or at least one prescription of disease-modifying anti-rheumatic drugs and/or two prescriptions of corticosteroids after the date of first diagnosis.
Results Cases were more often users of statins (15.9%) compared to controls (8.6%). After adjustment for cardiovascular risk factors and use of comedication, statin use was associated with an increased risk of incident RA (adjusted OR, 1.71 (95% CI 1.16 to 2.53); p=0.007). A consistent trend of increasing risk with increased cumulative duration, cumulative defined daily doses and number of prescriptions was not observed. However, a small trend between the potency of statin treatment and the risk of RA was found.
Conclusions Statin use seems to be associated with an increased risk of developing RA. Our findings should be replicated by additional studies.
Footnotes
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Funding This work was supported by research grant S340040 from the National Institute for Public Health and the Environment. The funder had no role in study design, in the analysis and interpretation of data, in the writing of the report or in the decision to submit the article for publication.
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Competing interests All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available upon request from the corresponding author) and declare (1) no support from any company for the submitted work; (2) no relationship with any company that might have an interest in the submitted work in the previous 3 years; (3) that their spouses, partners or children have no financial relationships that may be relevant to the submitted work; and (4) no non-financial interests that may be relevant to the submitted work.
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Provenance and peer review Not commissioned; externally peer reviewed
