Pleiotropic effects of statins in inflammation: friend or foe in human arthritis?

摘要

The statins (competitive HMG-CoA reductase inhibitors) form a class of hypolipidemic drugs used to lower cholesterol and triglycerides and are beneficial in primary and secondary prevention of coronary diseases. Recent studies indicate that statins, while curtailing cholesterol synthesis, exhibit alternate and/or pleiotropic effects attenuating inflammation, oxidative stress, endothelial function and thrombogenic responses. McCarey et al. show beneficial effects of statins on C-reactive protein, erythrocyte sedimentation and joint swelling in rheumatoid arthritis (RA), illustrating a role for statins in inflammation resolution. This paper brings to light several alternate effects of statins, specifically those associated with inflammation resolution and immune modulation, in addition to cardiovascular risks. Although ‘killing two birds with one stone’ is quite appealing, as described by McCarey et al., there are caveats in applying this approach too broadly. Clinical efficacy, long-term safety effects and the possibility of unwanted immune modulation warrant contemplation. Moreover, a particular statin may be contraindicated in some types of arthritis, whereas unwanted side effects on a molecular level or null clinical outcomes may result.