title: The impact of statins therapy on disease activity and inflammatory factor in patients with rheumatoid arthritis: a meta-analysis.
abstract: OBJECTIVE
  Statin is the most widely used as HMG-CoA reductase inhibitor, and contributes to clinically significant vascular risk reduction. However, the role of statins in the rheumatoid arthritis (RA) immunomodulation is debatable. This meta-analysis aimed to determine the efficacy of statins therapy in RA patients.
  
  
  METHODS
  A structured literature search was undertaken to identify randomised controlled trials (RCTs) conducted in RA patients receiving either statins or control. A meta-analysis on standardised mean difference (SMD) with a 95% confidence interval (95%CI) was conducted.
  
  
  RESULTS
  We included 15 studies with a total of 992 patients (487 patients allocated to statins therapy). Our data revealed statins can attenuate disease activity markedly. Overall, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) declined significantly during the treatment (n=12, SMD: -2.222, 95%CI: -2.404, -2.040, p=0.000; n=14, SMD: -3.014, 95%CI: -3.207, -2.821, p=0.000), among which ESR and CRP decreased obviously at 12 months (n=5, SMD: -2.874, 95%CI: -3.224, -2.523, p=0.000; n=7, SMD: -3.970, 95%CI: -4.300, -3.641, p=0.000; respectively). As expected, the tender joint count (TJC) and swollen joint count (SJC) also fell (n=9, SMD: -2.005, 95% CI: -2.216, -1.794; p=0.000; n=10, SMD: -1.76, 95%CI: -1.948, -1.577; p=0.000; respectively). Besides, morning stiffness was attenuated (n=5, SMD: -1.242, 95%CI: -1.474, -1.011, p=0.000), and showed no significant differences between 12 months and 24 months (p=0.205). Notably, statins indeed potently down-regulate inflammatory factors TNF-α (n=7, SMD: -4.290, 95%CI: -4.659, -3.922; p=0.000), IL-1 (n=4, SMD: -1.324, 95%CI: -1.646, -1.003; p=0.000), and IL-6 (n=10, SMD: -1.652, 95%CI: -1.822, -1.482; p=0.000). No publication bias was observed across all studies based on the Begg and Egger test.
  
  
  CONCLUSIONS
  This meta-analysis demonstrates the pleiotropic effects of statins on ameliorating RA activity and mediating clinically apparent anti-inflammatory effects in the context of RA autoimmune inflammation, which make it recommended as a potent treatment for RA patients.
authors.affiliation: Institute of Anatomy & Histology and Embryology, Shandong University School of Medicine, Jinan, Shandong, China.
authors.forename: Shunzeng
authors.initials: S
authors.lastname: Lv
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
authors.forename: Yuting
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
authors.forename: Zhigeng
authors.initials: Z
authors.lastname: Zou
authors.affiliation: Institute of Anatomy & Histology and Embryology, Shandong University School of Medicine, Jinan, Shandong, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Li
authors.affiliation: Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Shigang
authors.initials: S
authors.lastname: Zhao
authors.affiliation: Institute of Anatomy & Histology and Embryology, Shandong University School of Medicine, Jinan, Shandong, China.
authors.forename: Ranran
authors.initials: R
authors.lastname: Shi
authors.affiliation: Institute of Anatomy & Histology and Embryology, Shandong University School of Medicine, Jinan, Shandong, China.
authors.forename: Ruixiang
authors.initials: R
authors.lastname: Bian
authors.affiliation: Institute of Anatomy & Histology and Embryology, Shandong University School of Medicine, Jinan, Shandong, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Tian
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D015551:Autoimmunity / Q000187:drug effects; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D004185:Disability Evaluation; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D018836:Inflammation Mediators / Q000097:blood*; D007596:Joints / Q000187:drug effects / Q000473:pathology; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D018836:Inflammation Mediators