Cholesterol Drug May Help Rheumatoid Arthritis
List of Potential Benefits Continues to Grow for Lipitor, Other Statins
June 17, 2004 -- The cholesterol-lowering drug Lipitor offers modest but significant benefits to people with rheumatoid arthritis, a small study suggests.
A lot more study is needed. But the new finding broadens the list of benefits from an amazing class of cholesterol-lowering drugs known as statins. Examples of other statins include Crestor, Pravachol, and Zocor.
It's becoming increasingly clear that statins do more than lower cholesterol. One of these effects is on the immune system. Statins alter the complex chain of events that make tissues red, swollen, and painful -- a reaction known as inflammation. Inflammation lies at the heart of rheumatoid arthritis.
Might statins help people with arthritis? David W. McCarey, MD, and colleagues at the University of Glasgow decided to find out. They added either Lipitor or a placebo to the treatment regimens of 116 rheumatoid arthritis patients.
After six months, the patients who took Lipitor did a bit better than the others. They had lower scores on a medical index of rheumatoid arthritis activity. And they had fewer swollen joints, although they did not report significantly better health. In addition, the Lipitor group had lower levels of two markers of inflammation -- sed rate and C-reactive protein. The findings appear in the June 19 issue of The Lancet.
"Although the magnitude of change is modest, the significant reduction [in disease activity] provides proof of concept that pathways targeted by statins offer therapeutic opportunity in inflammatory disease," McCarey and colleagues write.
The researchers note that Lipitor added to the effect of other disease-modifying drugs the patients were taking. They suggest that longer treatment -- or, even better, new statin-like drugs specifically designed for rheumatoid arthritis patients -- might be even more helpful.
In an editorial accompanying the study, Karolinska Institute researchers Lars Klareskog, MD, PhD, and Anders Hamsten, MD, PhD, welcome the findings.
They note that patients with rheumatoid arthritis are at high risk of heart disease. Statins, they suggest, may kill two birds with one stone. They may lower this high risk of heart disease via their cholesterol-lowering action. And they may help treat arthritis itself. It's unclear exactly why rheumatoid arthritis patients are at high risk of heart disease, though it's felt to be related to the higher levels of inflammation in the body.
However, they note that the long-term effects of statins on the immune system are simply not known. Since rheumatoid arthritis is an autoimmune disease -- where the immune system attacks normal tissues as if they're foreign to the body -- it's not clear whether statins will help or hurt in the long run. As do McCarey and colleagues, they stress the need for statin makers to fund larger, longer studies in rheumatoid arthritis patients.