Statins for Osteoarthritis Knee Pain? Really?

Recent research suggests that cholesterol-lowering drugs may help knee osteoarthritis. Do we recommend the use of statins for knee pain? NO!

We do not feel that we need to make an argument for the non-usage of statin in knee pain, as this seems to fall under the category of common sense in medicine. We invite you to decide based on two studies: one suggesting statins play a role in knee pain and one that suggests statins offer no benefit and in fact make some cases of knee osteoarthritis worse.

All those in favor

“Osteoarthritis is the most frequent chronic joint disease causing pain and disability. Besides biomechanical mechanisms, the pathogenesis of osteoarthritis may involve inflammation, vascular alterations and dysregulation of lipid metabolism. As statins are able to modulate many of these processes, this study examines whether statin use is associated with a decreased incidence and/or progression of osteoarthritis.

Participants [2,921] in a prospective population-based cohort study aged 55 years and older were included. X-Rays of the knee/hip were obtained at baseline and after on average 6.5 years for osteoarthritis. Any increase in score was defined as overall progression [incidence and progression].

Statin use is associated with more than a 50% reduction in overall progression of osteoarthritis of the knee, but not of the hip.”1

All those against

“Recently published research suggests that statins may have beneficial structural effects in persons with knee osteoarthritis (OA). The potential effects of statins on patient-reported knee pain and function have not been examined. We studied a large prospective community-based cohort of persons with knee OA to determine if statin usage was associated with changes in knee structure, pain and function trajectories.

Data were obtained from the Osteoarthritis Initiative using a subset of 2207 persons with radiographically suspected or confirmed knee OA. The changes in Western Ontario and McMaster Universities Arthritis Index (WOMAC) Pain and Physical Function scores, pain intensity and Kellgren-Lawrence radiographic grade over 4 years were examined. [The same applied in the above study.]

Data from persons were coded based on whether they were incident users of statins over the 4-year period. Outcome trajectories and probability of statin use were examined over the 4-year study period using parallel processing growth curve modeling. The analysis adjusted for potential confounders and determined if statin use predicted outcome trajectories.

Statin use was not associated with improvements in knee pain, function or structural progression trajectories. The only significant finding indicated that increased duration of statin use was associated with worsening in WOMAC Physical Function scores over the study period. Statin use was not associated with improvements in knee pain, function or structural progression over the 4-year study period.”2

 

Bottom line: the study that used X-ray for evaluation showed that half of the participants showed improvements in osteoarthritis. The study that evaluated the patients based on pain levels, function, and structural changes showed no significant improvements and worsening pain and function scores. Regardless of what an X-ray shows, especially given its unreliability in showing soft tissue damage, if the patient is still suffering from symptoms of osteoarthritis, the treatment is clearly ineffective. The best treatment fro slowing progression of osteoarthritis is Prolotherapy.

Questions? Contact us here.
1. Stricker BH, Bierma-Zeinstra SM. Statin use is associated with reduced incidence and progression of knee osteoarthritis in the Rotterdam study. Ann Rheum Dis. 2012 May;71(5):642-7. Epub 2011 Oct 11.

2. Riddle DL, Moxley G, Dumenci L. Ann Rheum Dis. 2012 Nov 21. [Epub ahead of print]
Associations between Statin use and changes in pain, function and structural progression: a longitudinal study of persons with knee osteoarthritis.

 

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