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Zhang Z, Deng C, Ma X, Wu Q, Zhou F, Liu X. The association between statin use and osteoarthritis-related outcomes: An updated systematic review and meta-analysis. Front Pharmacol 2022; 13:1003370. [PMID: 36506528 PMCID: PMC9729269 DOI: 10.3389/fphar.2022.1003370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/25/2022] [Indexed: 11/25/2022] Open
Abstract
Objective: Findings among studies evaluating the effect of statin use and OA development in a 2020 meta-analysis of data from 11 observational studies of statin use and osteoarthritis (OA) revealed controversial results. We aimed to determine the associations between statin use and OA-related outcomes in an updated meta-analysis. Methods: The protocol was registered with PROSPERO (CRD42020163983). A systematic literature retrieval was performed in the online databases, including PubMed, Cochrane Library, Embase, Web of Science, and Scopus, from inception to 1 June 2022, for clinical studies that compared the effects of statin users vs. nonusers on OA-related outcomes risks. Systematic reviews and meta-analyses were performed to estimate the correlations between statin use and OA-related outcomes. Tendency analysis was also used to estimate dose-response effects. The risk of bias was evaluated with the Newcastle-Ottawa scale. Results: We included 23 studies involving more than 6,000,000 participants. Statin use was associated with increased OA risk (OR 1.099 [95%CI 1.002-1.206, p = 0.045]). Higher statin doses had higher OA risk (simvastatin equivalent daily of >40 mg). OA and related surgery risks were significantly reduced in statin users using antihypertensive drugs (AHDs). No significant differences were seen in other outcomes. Conclusion: This meta-analysis inferred that statin use might be associated with increased OA development, especially at higher doses. The present study highlights the importance of recognizing potential OA risk in the population with long-term and/or high-dose statin use, especially in older populations. In addition, AHDs are associated with lower OA risk and fewer surgeries in hypertensive statin users. Due to limitations of heterogeneity and confounders, more rigorous studies are needed to define the correlations between statin use and OA-related outcomes.
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Affiliation(s)
- Zhan Zhang
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chunbo Deng
- Department of Orthopedics, Central Hospital of Shenyang Medical College, Shenyang, China
| | - Xun Ma
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qijun Wu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fenghua Zhou
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xueyong Liu
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China,*Correspondence: Xueyong Liu,
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2
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Nesson ET, McDowell SA. Innovations in Evaluating Statin Benefit and Efficacy in Staphylococcus aureus Intracellular Infection Management. Int J Mol Sci 2022; 23:ijms232113006. [PMID: 36361794 PMCID: PMC9657138 DOI: 10.3390/ijms232113006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 11/23/2022] Open
Abstract
An emerging therapeutic approach in the treatment of infectious disease is to augment the host response through repurposing of well-tolerated, non-antibiotic, host-directed therapeutics. Earlier retrospective studies identify a positive association between statin use and a decreased risk of death due to sepsis or bacteremia. However, more recent randomized control trials fail to detect a therapeutic benefit in these complex infection settings. It is postulated that unrecognized biases in certain observational studies may have led to an overestimation of benefit and that statin use is instead a marker for health status, wealth, and demographic characteristics which may separately affect death due to infection. What remains unresolved is that in vitro and in vivo evidence reproducibly indicates that statin pharmacology limits infection and augments immunomodulatory responses, suggesting that therapeutic benefits may be attainable in certain infection settings, such as intracellular infection by S. aureus. Carefully considering the biological mechanisms capable of driving the relationship between statins and infections and constructing a methodology to avoid potential biases in observational studies would enable the examination of protective effects against infection and limit the risk of underestimating statin efficacy. Such an approach would rely on the examination of statin use in defined infection settings based on an underlying mode-of-action and pharmacology, where the inhibition of HMG-CoA-reductase at the rate-limiting step in cholesterol biosynthesis diminishes not only cholesterol levels but also isoprenoid intermediates central to host cell invasion by S. aureus. Therapeutic benefit in such settings, if existent, may be of clinical importance.
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Affiliation(s)
- Erik T. Nesson
- Department of Economics, Ball State University, Muncie, IN 47306, USA
| | - Susan A. McDowell
- Office of Research and Innovation, Miami University, Oxford, OH 45056, USA
- Correspondence:
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Kruisbergen NNL, van Gemert Y, Blom AB, van den Bosch MHJ, van Lent PLEM. Activation of circulating monocytes by low-density lipoprotein-a risk factor for osteoarthritis? Rheumatology (Oxford) 2022; 62:42-51. [PMID: 35863051 PMCID: PMC9788825 DOI: 10.1093/rheumatology/keac359] [Citation(s) in RCA: 2] [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: 11/23/2021] [Revised: 06/01/2022] [Accepted: 06/14/2022] [Indexed: 12/30/2022] Open
Abstract
Synovial macrophages are key mediators of OA pathology, and skewing of macrophage phenotype in favour of an M1-like phenotype is thought to underlie the chronicity of synovial inflammation in OA. Components of the metabolic syndrome (MetS), such as dyslipidaemia, can affect macrophage phenotype and function, which could explain the link between MetS and OA development. Recently published studies have provided novel insights into the different origins and heterogeneity of synovial macrophages. Considering these findings, we propose an important role for monocyte-derived macrophages in particular, as opposed to yolk-sac derived residential macrophages, in causing a pro-inflammatory phenotype shift. We will further explain how this can start even prior to synovial infiltration; in the circulation, monocytes can be trained by metabolic factors such as low-density lipoprotein to become extra responsive to chemokines and damage-associated molecular patterns. The concept of innate immune training has been widely studied and implicated in atherosclerosis pathology, but its involvement in OA remains uncharted territory. Finally, we evaluate the implications of these insights for targeted therapy directed to macrophages and metabolic factors.
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Affiliation(s)
- Nik N L Kruisbergen
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yvonne van Gemert
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arjen B Blom
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Peter L E M van Lent
- Correspondence to: Peter L.E.M. van Lent, Experimental Rheumatology, Radboud University Medical Center, Geert Grooteplein 28, 6525GA Nijmegen, The Netherlands. E-mail:
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Heidari B, Babaei M, Yosefghahri B. Prevention of Osteoarthritis Progression by Statins, Targeting Metabolic and Inflammatory Aspects: A Review. Mediterr J Rheumatol 2021; 32:227-236. [PMID: 34964026 PMCID: PMC8693300 DOI: 10.31138/mjr.32.3.227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 03/12/2021] [Accepted: 03/30/2021] [Indexed: 01/17/2023] Open
Abstract
Background and purpose: Several traditional risk factors of atherosclerosis such as age, obesity, and altered lipid metabolism are shared with osteoarthritis (OA). Metabolic abnormalities and atheromatous vascular disease are linked with systemic inflammation and progression of OA. Hence, treatment of OA with statins is expected to improve metabolic abnormalities and prevent OA progression. Many studies which have addressed this issue found inconsistent results. This review aims to elucidate the effect of statins in OA by summarizing the existing data. Methods: Potential studies in English language published in Medline/PubMed, Scopus and Google Scholar since 2000 were searched by using keywords such as osteoarthritis, statins, progression, treatment, prevalence, synovitis, pain. Fourteen papers were found to be relevant and were summarised. Results: Data regarding symptomatic effect of statins in OA are scarce and the results varied from no effect to a small improvement or even increased risk of pain in knee OA. However, most studies on the incidence and progression of OA found a significant decreased risk of incident OA, as well as reduced risk of radiographic progression in statin users vs. non-users. Factors such as patient adherence, duration of treatment, and higher cumulative statin doses were associated with greater efficacy. Conclusion: Existing data indicate a preventing effect of statin therapy on OA progression. However, unless a formal meta-analysis with weight analysis is made, a conclusion cannot be drawn.
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Affiliation(s)
- Behzad Heidari
- Mobility Impairment Research Centre, Babol University of Medical Sciences, Babol, Iran
| | - Mansour Babaei
- Mobility Impairment Research Centre, Babol University of Medical Sciences, Babol, Iran.,Department of Medicine, Division of Rheumatology, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Behnaz Yosefghahri
- Department of Medicine, Division of Rheumatology, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
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5
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Szarek A, Postawa P, Stachowiak T, Paszta P, Redutko J, Mordal K, Kalwik A, Łukomska-Szarek J, Gzik M, Joszko K, Rydz D, Łągiewka M, Gzik-Zroska B. The Analysis of Polyethylene Hip Joint Endoprostheses Strength Parameters Changes after Use inside the Human Body. Materials (Basel) 2021; 14:7091. [PMID: 34832490 DOI: 10.3390/ma14227091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/28/2021] [Accepted: 11/15/2021] [Indexed: 11/30/2022]
Abstract
The influence of dynamic loads resulting from human motor activity and electrocorrosion inside the human body on the strength parameters of artificial joint elements has not yet been investigated. Hip joint arthroplasty is the most common surgical procedure in the world that allows doctors to remove pain and restore motor skills in people with severe hip diseases, after accidents, and in the elderly. Based on the reports, this article assesses changes in the number of implanted endoprostheses in the years 2005–2019 and determines the trends and estimated changes in the number of implanted hip prostheses in the following decades. The study assesses changes in selected strength parameters of UHMW-PE polyethylene inserts of hip joint endoprostheses during their use in the human body. The research was carried out on appropriately collected samples from UHMW-PE cups removed from the human body with a known history and lifetime from 4 to 10 years. Patients’ body weight ranged from 735 [N] to 820 [N], and the declared physical activity was similar in the entire research group. As part of the research, the values of changes in dynamic modules and the mechanical loss coefficient were determined in relation to the share of the crystalline and amorphous phases of artificial UHMW-PE cups, removed from the human body after different periods of exploitation under similar operating conditions. The analysis of selected strength parameters was performed at a temperature of 40 °C, which corresponds to the working conditions inside the human body. On the basis of numerical studies, the influence of changes in material parameters on the deformation of the artificial acetabulum during the patient’s motor activity, which is one of the causes of fatigue destruction, was determined.
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Sutton SS, Magagnoli JC, Cummings TH, Hardin JW. Statin Exposure and Risk of Prosthetic Joint Infection After Total Knee or Hip Arthroplasty Among U.S. Veterans. J Arthroplasty 2021; 36:3584-3588.e1. [PMID: 34229942 DOI: 10.1016/j.arth.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Statins have a variety of pleiotropic effects that could be beneficial for patients undertaking total knee or hip arthroplasty. In vitro and in vivo models suggest the beneficial effects of statins through bone formation and modulating proinflammatory cytokines triggered by implant debris. However, statins also exhibit antimicrobial action and may reduce the risk of revision surgery via reducing the risk of infection. We sought to explore the relationship between statin use and prosthetic joint infection (PJI) after total knee or hip arthroplasty. METHODS We use a retrospective cohort of patients undergoing total knee or hip arthroplasty performed within the Department of Veterans Affairs. To minimize selection bias between the statin exposed and unexposed patients, we used 1:1 ratio propensity score matching. We fit adjusted Cox proportional hazards models to quantify the risk of PJI between the cohorts within 1 year, 3 years, and all follow-up time. RESULTS With a study period beginning from January 2000, a total of 60,241 patients were included. The unmatched Cox models reveal, over the entire follow-up time, a statistically significant lower risk of infection for the statin exposed patients (hazard ratio = 0.869; 95% confidence interval = [0.79-0.956]). The matched Cox model results reveal a statistically significant lower risk of PJI, only in the overall model, for the statin exposed cohort compared with the unexposed cohort (hazard ratio = 0.895, 95% confidence interval = [0.807-0.993]). CONCLUSION Our analysis finds some support for the beneficial effects of statins for preventing PJI among patients undergoing total knee or hip arthroplasty.
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Abstract
Osteoarthritis (OA) is a chronic joint disorder that causes degeneration of
cartilage, synovial inflammation, and formation of osteophytes. Aging, obesity,
and sex are considered the main risk factors of OA. Recent studies have
suggested that metabolic syndrome (MetS) disorders, such as hypertension,
hyperlipidemia, diabetes mellitus, and obesity, may be involved in the
pathogenesis and progression of OA. MetS disorders are common diseases that also
result in atherosclerosis. Researchers believe that OA and atherosclerosis have
underlying similar molecular mechanisms because the prevalence of both diseases
increases with age. Oxidation of low-density lipoprotein (ox-LDL) is believed to
play a role in the pathogenesis of atherosclerosis. Recent reports have shown
that ox-LDL and low-density lipoprotein receptor 1 (LOX-1) are involved in the
pathogenesis of OA. The purpose of this narrative review is to summarize the
current understanding of the role of the LOX-1/ox-LDL system in the pathogenesis
of OA and to reveal common underlying molecular pathways that are shared by MetS
in OA and the LOX-1/ox-LDL system.
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Affiliation(s)
- Kazuhiko Hashimoto
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka, Japan
| | - Masao Akagi
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka, Japan
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Sorial AK, Anjum SA, Cook MJ, Board TN, O'Neill TW. Statins, bone biology and revision arthroplasty: review of clinical and experimental evidence. Ther Adv Musculoskelet Dis 2020; 12:1759720X20966229. [PMID: 33403020 PMCID: PMC7747105 DOI: 10.1177/1759720x20966229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/10/2019] [Accepted: 09/14/2020] [Indexed: 12/27/2022] Open
Abstract
Osteoarthritis is a painful, disabling condition which is increasing in
prevalence as a result of an ageing population. With no recognized
disease-limiting therapeutics, arthroplasty of the hip and knee is the most
common and effective treatment for lower limb osteoarthritis, however lower limb
arthroplasty has a finite life-span and a proportion of patients will require
revision arthroplasty. With increasing life expectancy and an increasing
proportion of younger (<65 years) patients undergoing arthroplasty, the
demand for revision arthroplasty after implant failure is also set to
increase. Statins are cholesterol-modulating drugs widely used for cardiovascular risk
reduction which have been noted to have pleiotropic effects including
potentially influencing arthroplasty survival. In vitro studies
have demonstrated pleiotropic effects in human bone cells, including enhancement
of osteoblastogenesis following simvastatin exposure, and in
vivo studies have demonstrated that intraperitoneal simvastatin can
increase peri-implant bone growth in rats following titanium tibial implant
insertion. There is evidence that statins may also influence osseointegration,
enhancing bone growth at the bone–implant interface, subsequently improving the
functional survival of implants. Data from the Danish Hip Arthroplasty Registry
and the Clinical Practice Research Datalink in the UK suggest a reduction in the
risk of lower limb revision arthroplasty in statin ever-users
versus never-users, and a time-dependent effect of statins
in reducing the risk of revision. In this article we review the clinical and
experimental evidence linking statins and risk of revision arthroplasty.
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Affiliation(s)
- Antony K Sorial
- Newcastle University, Biosciences Institute, International Centre for Life, Newcastle upon Tyne, NE1 3BZ, UK
| | | | - Michael J Cook
- Centre for Epidemiology versus Arthritis, University of Manchester, Manchester, UK
| | - Tim N Board
- The Centre for Hip Surgery, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Terence W O'Neill
- Centre for Epidemiology versus Arthritis, University of Manchester, Manchester, UK, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK
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Szarek A, Stradomski G, Łukomska-Szarek J, Rydz D, Wolański W, Joszko K. Wear Morphology on the Surfaces of CoCrMo Unicompartmental Knee Joint Endoprostheses as Elements of Metal-Metal Friction Nodes. Materials (Basel) 2020; 13:E2689. [PMID: 32545611 PMCID: PMC7345842 DOI: 10.3390/ma13122689] [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] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 01/17/2023]
Abstract
The article assesses the strength and structural parameters of load-bearing layers of metal biobearings made of CoCrMo alloy. The research material consisted of unicompartmental knee joint endoprostheses used in the human body, removed due to excessive wear. No patient participated in the examinations. The endoprostheses used as research material underwent the liquidation procedures in the hospital, which has all necessary permissions and certifications to perform endoprosthetic procedures. Endoprostheses selected for the examinations had been used for 6 to 12 years at similar load conditions as declared by the patients, i.e., body weight of F = 835 N, declared activity expressed as the number of load cycles up to 100 thousand/year, and no artificial joint infections. To assess the homogeneity of the research material, the analysis of chemical composition using a Joel scanning electron microscope with EDS (Energy-dispersive X-ray spectroscopy) was made to exclude endoprostheses with various alloying additives. Microscopic examinations were performed using the Phenom XL microscope, while the wear surface was examined using a Keyence VHX-900F microscope. Several experimental tests were also carried out on load-bearing surfaces to assess changes in strength parameters of the base material after a known life cycle and load conditions. Material hardness using the Vickers method, yield point, critical value of stress intensity coefficient, and the coefficient of friction µ were evaluated. The examinations allowed for the systematization of wear in the knee and femoral components of unicompartmental hip endoprostheses. The statistical evaluation of the number and costs of hip joint replacement surgeries in Poland was also made.
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Affiliation(s)
- Arkadiusz Szarek
- Faculty of Mechanical Engineering and Computer Science, Department of Technology and Automation, Czestochowa University of Technology, 21 Armii Krajowej Av., 42-201 Czestochowa, Poland;
| | - Grzegorz Stradomski
- Faculty of Production Engineering and Materials Technology, Czestochowa University of Technology, 19 Armii Krajowej Av., 42-201 Czestochowa, Poland; (G.S.); (D.R.)
| | - Justyna Łukomska-Szarek
- Faculty of Management, Czestochowa University of Technology, 19 B Armii Krajowej Av., 42-201 Czestochowa, Poland;
| | - Dariusz Rydz
- Faculty of Production Engineering and Materials Technology, Czestochowa University of Technology, 19 Armii Krajowej Av., 42-201 Czestochowa, Poland; (G.S.); (D.R.)
| | - Wojciech Wolański
- Faculty of Biomedical Engineering, Department of Biomechatronics, Silesian University of Technology, 40 Roosevelta Av., 41-800 Zabrze, Poland;
| | - Kamil Joszko
- Faculty of Biomedical Engineering, Department of Biomechatronics, Silesian University of Technology, 40 Roosevelta Av., 41-800 Zabrze, Poland;
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Benkovich V, Klassov Y, Mazilis B, Bloom S. Periprosthetic fractures of the knee: a comprehensive review. Eur J Orthop Surg Traumatol 2019; 30:387-399. [PMID: 31745642 PMCID: PMC7138771 DOI: 10.1007/s00590-019-02582-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 10/15/2019] [Indexed: 12/28/2022]
Abstract
Demographic changes have resulted in an increase in the number of older patients diagnosed with degenerative joint disease. Developments in the field of joint arthroplasty allow a broader population to improve their lifestyles. An increased demand for knee arthroplasty has led to a rise in operations performed worldwide. Although there has been a constant propagation of technology and an increase in medical staffing at a professional level, many patients still encounter complications. Though rare, these factors may lead to life-threatening scenarios and a devastating effect on the success of the operation. One such rare complication includes periprosthetic fractures around the knee, a complex injury which requires a cautious and experienced approach. In this review, we analyze the prevalence, risk factors and classification, investigation and treatment options for periprosthetic fractures with total knee arthroplasty.
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Affiliation(s)
- Vadim Benkovich
- Department of Joint Arthroplasty, “Yonatan” Center-Israeli Joint and Spine Health Center, Assuta Medical Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yuri Klassov
- Orthopedic Surgery Department, Soroka University Medical Center, Beer-Sheva, Israel
| | - Boris Mazilis
- Ben Gurion University, Soroka medical Center, Beer-Sheva, Israel
| | - Shlomo Bloom
- Orthopedic Surgery Department, Soroka University Medical Center, Beer-Sheva, Israel
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