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van Boheemen L, Turk S, Beers-Tas MV, Bos W, Marsman D, Griep EN, Starmans-Kool M, Popa CD, van Sijl A, Boers M, Nurmohamed MT, van Schaardenburg D. Atorvastatin is unlikely to prevent rheumatoid arthritis in high risk individuals: results from the prematurely stopped STAtins to Prevent Rheumatoid Arthritis (STAPRA) trial. RMD Open 2021; 7:e001591. [PMID: 33685928 PMCID: PMC7942258 DOI: 10.1136/rmdopen-2021-001591] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Persons at high risk of rheumatoid arthritis (RA) might benefit from a low-risk pharmacological intervention aimed at primary prevention. Previous studies demonstrated disease-modifying effects of statins in patients with RA as well as an association between statin use and a decreased risk of RA development. A randomised, double-blind, placebo-controlled trial investigated whether atorvastatin could prevent arthritis development in high-risk individuals. METHODS Arthralgia patients with anticitrullinated protein antibody (ACPA) >3 xULN or ACPA and rheumatoid factor, without (a history of) arthritis, were randomised to receive atorvastatin 40 mg daily or placebo for 3 years. The calculated sample size was 220 participants. The primary endpoint was clinical arthritis. Cox regression analysis was used to determine the effect of atorvastatin on arthritis development. RESULTS Due to a low inclusion rate, mainly because of an unwillingness to participate, the trial was prematurely stopped. Data of the 62 randomised individuals were analysed. Median follow-up was 14 (inner quartiles 6-35) months. Fifteen individuals (24%) developed arthritis: 9/31 (29%) in the atorvastatin group; 6/31 (19%) in the placebo group: HR 1.40, 95% CI 0.50 to 3.95. CONCLUSIONS In this small set of randomised high-risk individuals, we did not demonstrate a protective effect of atorvastatin on arthritis development. The main reason for the low inclusion was unwillingness to participate; this may also impede other RA prevention trials. Further research to investigate and solve barriers for prevention trial participation is needed.
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Affiliation(s)
- Laurette van Boheemen
- Rheumatology, Reade, Amsterdam Rheumatology and Immunology Center, Amsterdam, Noord-Holland, The Netherlands
| | - Samina Turk
- Rheumatology, Reade, Amsterdam Rheumatology and Immunology Center, Amsterdam, Noord-Holland, The Netherlands
| | - Marian van Beers-Tas
- Rheumatology, Reade, Amsterdam Rheumatology and Immunology Center, Amsterdam, Noord-Holland, The Netherlands
| | - Wouter Bos
- Rheumatology, Reade, Amsterdam Rheumatology and Immunology Center, Amsterdam, Noord-Holland, The Netherlands
| | - Diane Marsman
- Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Ed N Griep
- Rheumatology, Antonius Hospital Sneek, Sneek, The Netherlands
| | | | - Calin D Popa
- Rheumatology, Bernhoven Hospital Location Uden, Uden, The Netherlands
- Rheumatology, Radboudumc, Nijmegen, The Netherlands
| | - Alper van Sijl
- Rheumatology, Reade, Amsterdam Rheumatology and Immunology Center, Amsterdam, Noord-Holland, The Netherlands
| | - Maarten Boers
- Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
- Rheumatology and immunology, AI&I, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
| | - Michael T Nurmohamed
- Rheumatology, Reade, Amsterdam Rheumatology and Immunology Center, Amsterdam, Noord-Holland, The Netherlands
- Rheumatology and immunology, AI&I, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
| | - Dirkjan van Schaardenburg
- Rheumatology, Reade, Amsterdam Rheumatology and Immunology Center, Amsterdam, Noord-Holland, The Netherlands
- Rheumatology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
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Beers-Tas MV, Nielen MM, Twisk JWR, Korevaar J, van Schaardenburg D. Increased primary care use for musculoskeletal symptoms, infections and comorbidities in the years before the diagnosis of inflammatory arthritis. RMD Open 2020; 6:rmdopen-2019-001163. [PMID: 32641448 PMCID: PMC7425115 DOI: 10.1136/rmdopen-2019-001163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/10/2020] [Accepted: 04/09/2020] [Indexed: 01/10/2023] Open
Abstract
Objectives Little is known about relevant events in the at-risk phase of rheumatoid arthritis before the development of clinically apparent inflammatory arthritis (IA). The present study assessed musculoskeletal symptoms, infections and comorbidity in future IA patients. Methods In a nested case–control study using electronic health records of general practitioners, the frequency and timing of 192 symptoms or diseases were evaluated before a diagnosis of IA, using the International Classification of Primary Care coding system. Cases were 2314 adults with a new diagnosis IA between 2012 and 2016; controls were matched 1:2. The frequency of primary care visits was compared using logistic regression. Results The frequency of visits for musculoskeletal symptoms (mostly of shoulders, wrists, fingers and knees) and carpal tunnel syndrome was significantly higher in IA patients vs controls within the final 1.5 years before diagnosis, with ORs of 3.2 (95% CI 2.8 to 3.5), 2.8 (95% CI 2.5 to 3.1) and 2.5 (95% CI 2.2 to 2.8) at 6, 12 and 18 months before diagnosis, respectively. Also, infections (notably of the genital and urinary tracts), IA-comorbidities and chronic diseases were more prevalent in cases than controls, but more evenly spread out over the whole 6-year period before IA. A decision tree was created including all symptoms and diseases. Conclusion There was an increased frequency of primary care visits for musculoskeletal symptoms, infections and comorbidities prior to the diagnosis of IA. This diverging trend is present for 4–6 years, but becomes statistically significant 1.5 years before the diagnosis. Validation of these results is warranted.
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Affiliation(s)
- Marian van Beers-Tas
- Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | - Markus Mj Nielen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Joke Korevaar
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
| | - D van Schaardenburg
- Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands.,Rheumatology, Amsterdam Rheumatology & immunology Center, Amsterdam University Medical Center location AMC, Amsterdam, The Netherlands
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Lübbers J, Vosslamber S, van de Stadt LA, van Beers-Tas M, Wesseling JG, von Blomberg BME, Witte BI, Bontkes HJ, van Schaardenburg D, Verweij CL. B cell signature contributes to the prediction of RA development in patients with arthralgia. Ann Rheum Dis 2015; 74:1786-8. [PMID: 26019192 DOI: 10.1136/annrheumdis-2015-207324] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/26/2015] [Indexed: 11/04/2022]
Affiliation(s)
- Joyce Lübbers
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Saskia Vosslamber
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | - John G Wesseling
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Birgit I Witte
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Hetty J Bontkes
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Dirkjan van Schaardenburg
- Jan van Breemen Research Institute
- Reade, Amsterdam, The Netherlands Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Cornelis L Verweij
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
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