Pattern of risks of rheumatoid arthritis among patients using statins: A cohort study with the clinical practice research datalink

• Published in: PloS one Vol. 13; no. 2; p. e0193297
• Main Authors: de Jong, Hilda J I, Cohen Tervaert, Jan Willem, Lalmohamed, Arief, de Vries, Frank, Vandebriel, Rob J, van Loveren, Henk, Klungel, Olaf H, van Staa, Tjeerd P
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 23.02.2018; Public Library of Science (PLoS)
• Subjects: Arthritis; Atherosclerosis; Biology and Life Sciences; Cardiovascular diseases; Clinical trials; Cohort analysis; Complications and side effects; Cytokines; Development and progression; Diabetes; Disease susceptibility; Dosage and administration; Exposure; Family medical history; Health risk assessment; Health risks; Hormone replacement therapy; Hyperlipidemia; Lymphocytes; Medicine and Health Sciences; Patients; Pharmaceutical sciences; Pharmacology; Pharmacy; Population studies; Practice research; Public health; Research and Analysis Methods; Rheumatoid arthritis; Risk analysis; Risk factors; Statins; Studies; Netherlands; United Kingdom > UK
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0193297

We examined the association between statin use and the risk of rheumatoid arthritis (RA), with special focus on describing the patterns of risks of RA during statin exposure in a large population-based cohort in the United Kingdom. In the Clinical Practice Research Datalink, patients aged ≥40 years with at least one prescription of statins (1995-2009) were selected, and matched by age (+/-5 years), sex, practice and date of first prescription of statins to non-users. The follow-up period of statin use was divided into periods of current, recent and past exposure, with patients moving between these three exposure categories over time. Time-dependent Cox models were used to derive hazard ratios (HRs) of RA, adjusted for disease history and previous drug use. The study population included 1,023,240 patients, of whom 511,620 were statin users. No associations were found between RA and current (HRadj,1.06;99%CI:0.88-1.27) or past statin users (HRadj,1.18;99%CI:0.88-1.57). However, in patients who currently used statins, hazard rates were increased shortly after the first prescription of statins and then gradually decreased to baseline level. The risk of developing RA was increased in recent statin users, as compared to non-users (HRadj,1.39;99%CI:1.01-1.90). The risk of RA is substantially increased in the first year after the start of statins and then diminishes to baseline level. These findings may suggest that statins might accelerate disease onset in patients susceptible to develop RA, but in other patients, statins are probably safe and well tolerated, even after prolonged use. Alternatively, we cannot rule out that confounding by cardiovascular risk factors and ascertainment bias may have influenced the findings.