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ISSN: 0034-6233
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Statins in rheumatology: revisited

Piotr Głuszko
Krzysztof Bonek

Reumatologia 2014; 52, 6: 351–353
Data publikacji online: 2014/11/29
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An increase in cardiovascular risk (CVD), including myocardial infarction and cardiac death, accompanying such diseases as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), inflammatory spondyloarthropaties, particularly psoriatic arthritis (PsA) is currently a well-known and documented fenomenon [1, 2]. A prominent role in the pathogenesis of the rapid development of vascular atherosclerotic changes is attributed to inflammatory mediators. However, at the same time, there are reports of multiple lipid disorders [3]. Consequently, for some time now, there has been a dispute concerning the usefulness of statins in the treatment (atheromatous plaque stabilization), in the prevention of the development of atherosclerotic lesions and in the secondary prevention of cardiovascular complications in the most common inflammatory rheumatic diseases [4, 5]. In addition, it has been known some years that the effects of statins are not limited to the normalization of blood cholesterol levels. In fact, the pleiotropic activity of the drugs indicates that they exert antiinflammatory and antithrombotic effects, modulate the immune response and even have a favourable effect on bone metabolism [6].
A more in-depth knowledge of the pharmacology of these drugs, especially in terms of their antiinflammatory properties, gives a clear argument in favour of attempts to use them in such diseases as RA. The preliminary findings were promising. The results of the TARA study published in 2004 [7] demonstrated a statistically significant decrease in the values of DAS28, ESR and C-reactive protein (CRP) in patients treated with atorvastatin. However, further trials showing a beneficial effect of statins in the terms of their antiinflammatory effects and their role in reducing the risk of CVD [5] have been relatively scarce. Further verification is therefore necessary, and experts still have not specified clear-cut recommendations for using statins in this patient group [8]. In addition, the known hepatotoxicity of these drugs, and the risk of myopathy and adverse immunomodulatory processes manifested as the induction of lupus-like syndromes, polymyositis, hepatitis and even pemphigus [6, 9], mean that extra caution has always been advised in patients suffering from autoimmune diseases and chronically taking drugs which often cause liver damage (NSAIDs, methotrexate, leflunomide).
Several years ago, in 2009, the European League Against Rheumatism...

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