Cholesterol Drugs Offer Hope Against Rheumatoid Arthritis

They reduced inflammation as well as risk factors for heart disease

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By
HealthDay Reporter

MONDAY, Oct. 27, 2003 (HealthDayNews) -- The cholesterol-lowering drugs known as statins show promise as a therapy for rheumatoid arthritis.

In the first study of its kind, researchers found statins eased some of the inflammation that is a characteristic of rheumatoid arthritis (RA), while reducing cholesterol levels and other risk factors for cardiovascular disease.

The findings, presented this week at the American College of Rheumatology's annual scientific meeting in Orlando, Fla., are key because people suffering from rheumatoid arthritis are twice as likely to develop serious cardiovascular disease as the general population, the study authors say.

"This is very important and potentially a turning point in the way in which we think about treating rheumatoid arthritis," says Dr. John Klippel, president and chief executive officer of the Arthritis Foundation.

"I would say that this is probably one of the more important studies that are going to be presented in Orlando for a couple of reasons," he adds. "First, people with rheumatoid arthritis die early, so there's a premature mortality associated with the disease. And one of the major reasons they die is from cardiovascular disease."

In this study, done by researchers at the Center for Rheumatic Diseases in Glasgow, Scotland, 116 patients were randomly selected to receive either a statin or a placebo for six months. At the end of that period, the researchers measured each participants' DAS 28 score (a score used mainly in Europe to assess RA), as well as blood concentrations of C-reactive protein. This is a protein that increases during inflammatory conditions such as atherosclerosis and RA.

The researchers found a small but statistically significant reduction in the DAS 28 in people who received atorvastatin compared with the placebo group. There was also a "highly significant" reduction in C-reactive protein levels, as well as total cholesterol, LDL ("bad") cholesterol and triglycerides.

Statins, then, appear to have a dual effect, reducing the risk of cardiovascular disease in people with RA and also reducing the inflammation that is responsible for the joint damage that is the hallmark of the disease.

The findings also indicate statins may derive at least part of their benefit by acting on inflammatory processes.

"What is the predominant influence of statins? Is it through lipids or is it through some effect on inflammation or is it some combination of the two? I think those are unresolved and very important questions at this point," Klippel says. "The use of a statin, which heretofore people have thought of as important because it has effects on lipids [blood fats], not only has the ability to lower lipids but also has the ability to influence inflammation."

Is this study enough to warrant a change in treatment regimens? Probably not.

"It certainly opens up an avenue of therapy that would involve statins which might become very important in the management of rheumatoid arthritis. But we can't change practice based on one study," Klippel says.

Another study being presented at the meeting found that aggressive outpatient care for people with early stage rheumatoid arthritis could also make a difference in the progression of the disease. Individuals who received monthly outpatient assessments that included injections of corticosteroids as well as a protocol to escalate certain drugs showed an improvement in their disease after 18 months. They also had better physical function, quality of life and less joint damage.

Yet another study found that giving the drugs alefacept and methotrexate was an effective combination for rheumatoid arthritis. Alefacept is a biologic drug that works by specifically targeting certain immune system responses in the body. Methotrexate is also used as a chemotherapy agent.

More information

For more on rheumatoid arthritis, visit the Arthritis Foundation. For more on statins, visit the American Heart Association.

SOURCES: John Klippel, M.D., president and chief executive officer, Arthritis Foundation, Atlanta; Oct. 23-28, 2003, presentation, American College of Rheumatology annual scientific meeting, Orlando, Fla.

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