The Effects of HMG-CoA Inhibitors (Statins) on Rheumatoid Arthritis Disease Progression: A Systematic Review

Background: Rheumatoid arthritis is a chronic, progressive autoimmune disease that erodes joint synovium and affects other body organs and vasculature. While current therapies, designed to address the impact of rheumatoid arthritis on joints, have been shown to be of benefit, the disabling and progression nature of the disease remains. In addressing the cardiovascular complications of this disease, providers may have stumbled upon another medication, a cholesterol lowering medication known as statins, which may prove beneficial for patients by decreasing inflammation and slowing disease progression. This review will examine the impact of statin medications of rheumatoid arthritis disease progression, as assessed by the DAS28. Method: An exhaustive search of the literature was conducted in Medline (Ovid) and Web of Science using the following search terms: rheumatoid arthritis, HMG Co-A inhibitor, statin, “severity of illness index”, disease progression, and treatment outcome. A search in CINAHL required the additional keywords anticholesteremic agents and antilipemic agent. Studies that assessed the effect of statin medications on DAS28, an index used to assess rheumatoid arthritis severity, were included. Studies were further limited to human subjects, adults, and English language. Results: A total of 132 results were found, 17 of which were further screened using the eligibility criteria, and five studies qualified for this systematic review. Four studies are randomized clinical trials, including one crossover study, and one is a prospective cohort study. In all studies, statin medications were shown to improve specific inflammatory markers (such as swollen joint counts, tender joint counts, CRP, and ESR), however, only three studies demonstrated their improvement of the DAS28 itself. Conclusion: The results of this systematic review demonstrate a trend of decreased inflammation in rheumatoid arthritis patients relatable to statin therapy; however, the picture remains unclear as to the improvement in rheumatoid arthritis disease progression with adjuvant statin use. Keywords: rheumatoid arthritis, DAS28, disease activity, disease progression, HMG-CoA inhibitor, severity of illness, statin, treatment outcom