TOKYO, Japan—In addition to their known lipid-lowering effects, statins may also reduce disease activity in rheumatoid arthritis (RA) patients, according to a new study in the May issue of the Journal of Rheumatology.¹

"Patients taking statins had significantly lower disease activity assessed by CRP (C-reactive protein), pain assessment, physician assessment, swollen joint count, and tender joint count," chief researcher Hiroshi Okamoto, MD, and colleagues with the Institute of Rheumatology at the Tokyo Women's Medical University, in Tokyo, Japan, conclude. There were, however, no statistical differences in disease activity score-28 (DAS-28) or the health assessment questionnaire (HAQ) among RA patients not taking statins and patients taking statins, who were more likely to be taking corticosteroids, which could have played a role in the findings, the study authors point out.

Exactly how statins reduce inflammation in RA is not fully understood, but they may suppress cytokine release and major histocompatibility complex class II in vitro, the researchers speculate.

A total of 7512 RA patients were enrolled in a single-institute-based prospective observational cohort and the researchers collected their information biannually. Cross-sectional data for 4152 patients, of whom 83.3% were female and an average age of 58.4, were analyzed in October 2003 via the Mann-Whitney U-test.

Among the 4152 patients with RA, 279 (6.7%) were taking statins. The patients taking statins had lower CRP (.85 vs 1.24 mg/dL, respectively), had lower swollen joint counts (1.80 vs 2.55), and were more likely to use higher doses of steroids than their nonstatin counterparts, 2.88 vs 2.40 mg/d, respectively.

The corticosteroid conundrum

Since serum cholesterol level was closely related to the use of corticosteroids, researchers controlled corticosteroid doses. "Even at the same dose level of corticosteroids, patients taking statins had several significantly lower measures of disease activity including patient's pain assessment, physician's assessment, and swollen joint counts," they note.

"In combination with steroid therapy it would be difficult for statins to have a significant additional effect in inflammation above that provided by corticosteroids," they write. "This may explain why patients taking statins but not taking >1 mg prednisolone a day seemed to have a more noticeable anti-inflammatory effect."

‘Joint' benefit possible for people with RA on statins

The new study is "interesting because there has been at least one other trial that shows some efficacy for statins for improving the joint activity in RA," S. Louis Bridges, Jr, MD, PhD, associate professor of medicine at University of Alabama at Birmingham, told CIAOMed. "We should not be putting RA patients on statins for their RA yet. At some point in future, we may use statins for disease activity in RA, but right now it's a little premature," he said.

"It is very important that RA patients be screened very aggressively for indications for statins. We should not miss any of those people. There may be a joint benefit—joint meaning dual, and joint meaning in the joint," Dr. Bridges concluded.

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Reference

1. Okamoto H, Koizumi K, Kamitsuji S, et al. Beneficial action of statins in patients with rheumatoid arthritis in a large observational cohort. J Rheumatol. 2007;34:964-968.