Background In patients with rheumatoid arthritis (RA) treated with statins it is difficult to establish their pleiotropic, including anti-inflammatory, effect due to the high activity of the inflammatory process in the course of the disease. This concerns, in particular, the daily clinical practice in which small and medium doses of statins are used, for safety reasons.
Objectives The aim of the study was to assess the effect of atorvastatin (ATS) treatment in patients with RA on specific complex indices of the disease activity, complex indices of vascular endothelial activation and activity of selected pro-atherogenic chemokines.
Methods The observation included a group of 62 RA patients currently treated with methotrexate (women – 93.5%, age – 59.3±7.1 years, disease duration – 8.2±8.0 years, presence of anti-CCP antibodies – 69.8%). 36 patients (studied group, 58.1%) received 16 weeks treatment with ATS (10 mg daily) and dietary recommendations (according to ATP III), and the remaining patients (control group) only dietary recommendations. In all patients the disease activity score (DAS28 with ESR) was calculated, and serum levels of anti-CCP antibodies, chemokines (CX3CL1 – fractalkine, CCL2 – monocyte chemotactic protein-1, CCL5 – RANTES) and soluble endothelial factors (ICAM-1 – intercellular adhesion molecule-1, VEGF – vascular endothelial growth factor) were determined (ELISA, R&D Systems). Each single result (X) was then transformed into a figure in the 0–1 range according to the selected formula (X/mean for the whole group + SD). The following complex indices were established: clinical disease activity (Clin-Score = DAS28 + anti-CCP), vascular endothelial activation (Endo-Score = ICAM-1 + VEGF), chemokines activity (Chemo-Score = CX3CL1 + CCL2 + CCL5) and the mixed index (Mixed-Score = CRP + CCL5 + ICAM-1). The statistical analysis of the atorvastatin treatment effect on the selected complex indices and their components was performed with the Mann-Whitney and Wilcoxon tests (Statistica v. 10).
Results Following the ATS treatment, statistically significant reduction in the levels of ICAM-1 (observation baseline and endpoint, 131 pg/ml vs. 111 pg/ml respectively, p<0.001), CCL5 (1306 pg/ml vs. l067 pg/ml, p<0.001), Clin-Score (1.12 vs. 0.98, p=0.034) and Chemo-Score (1.84 vs. 1.22, p<0.0001) were observed. After 16 weeks of observation in the control group, ICAM-1 (129 pg/ml vs. 114 pg/ml, p=0.013), CCL5 (1229 pg/ml vs. 1036 pg/ml, p=0.015) and Chemo-Score (1.86 vs. 1.29, p=0.004) decreased. After 16 weeks, no statistically significant changes in Endo-Score, Mixed-Score and other clinical and laboratory parameters were observed either in the studied or in the control group.
Conclusions Treatment with small, and thus safer, doses of ATS can reduce both the clinical activity of RA, as well as levels of pro-atherogenic chemokines. The advantageous effect of statins can be more visible when complex clinical and laboratory disease indices are used.
Disclosure of Interest None declared