{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T23:59:51Z","timestamp":1793145591575,"version":"4.5.0"},"reference-count":20,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2021,3,7]],"date-time":"2021-03-07T00:00:00Z","timestamp":1615075200000},"content-version":"unspecified","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100018286","name":"Dutch Arthritis Society","doi-asserted-by":"crossref","award":["13-1-501"],"award-info":[{"award-number":["13-1-501"]}],"id":[{"id":"10.13039\/100018286","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2021,2,23]]},"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Arthralgia patients with anticitrullinated protein antibody (ACPA) &gt;3\u2009xULN or ACPA and rheumatoid factor, without (a history of) arthritis, were randomised to receive atorvastatin 40\u2009mg 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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\u201335) months. Fifteen individuals (24%) developed arthritis: 9\/31 (29%) in the atorvastatin group; 6\/31 (19%) in the placebo group: HR 1.40, 95%\u2009CI 0.50 to 3.95.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2021-001591","type":"journal-article","created":{"date-parts":[[2021,3,8]],"date-time":"2021-03-08T00:25:17Z","timestamp":1615163117000},"page":"e001591","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":62,"title":["Atorvastatin is unlikely to prevent rheumatoid arthritis in high risk individuals: results from the prematurely stopped STAtins to Prevent Rheumatoid Arthritis (STAPRA) trial"],"prefix":"10.1136","volume":"7","clinical-trial-number":[{"clinical-trial-number":"nct02603146","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3168-548X","authenticated-orcid":false,"given":"Laurette","family":"van Boheemen","sequence":"first","affiliation":[{"name":"Rheumatology, Reade, Amsterdam Rheumatology and Immunology Center, 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Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3103-1374","authenticated-orcid":false,"given":"Diane","family":"Marsman","sequence":"additional","affiliation":[{"name":"Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ed N","family":"Griep","sequence":"additional","affiliation":[{"name":"Rheumatology, Antonius Hospital Sneek, Sneek, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirian","family":"Starmans-Kool","sequence":"additional","affiliation":[{"name":"Rheumatology, Zuyderland Medisch Centrum Heerlen, Heerlen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9470-9720","authenticated-orcid":false,"given":"Calin D","family":"Popa","sequence":"additional","affiliation":[{"name":"Rheumatology, Bernhoven Hospital Location Uden, Uden, The 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Increased risk of rheumatoid arthritis diagnosis in statin users in a large nationwide US study. 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