In scleroderma, the immune system mistakenly attacks connective tissue, tissue that supports and holds organs together and found in the joints. These attacks triggers damage responses that include excessive production of collagen, a major component of scar tissue. Scleroderma can cause a variety of symptoms, depending on the organs it affects.
No cure exists, but various therapies can help manage the symptoms of scleroderma. Statins are currently under investigation as a possible treatment for this disease.
What are statins?
Statins are a group of medications that act to regulate the level of certain lipids, or fat molecules, in the body.
Commonly, they are prescribed to patients with high levels of cholesterol, a type of lipid. High levels of “bad” — or LDL — cholesterol can cause health problems, including heart disease, and restrict blood flow by clogging arteries.
Statins are sometimes referred to as HMG-CoA reductase inhibitors, as they block the activity of the HMG-CoA reductase enzyme. This enzyme is involved in the production of cholesterol and certain other fats in the body. Inhibiting its activity works to reduce cholesterol levels.
Independent of their effect on cholesterol, statins can also act on the vascular system. Research suggests that statins act on the vascular endothelium, a layer of cells that control the relaxing and constricting of the arteries, and also has a role in immune responses. This, in turn, suggests that statins have immunomodulatory properties, and may be able to reduce inflammatory responses produced by the endothelium.
Statins in scleroderma
The vascular system is often affected in scleroderma. The narrowing of the blood vessels caused by the disease leaves patients at risk of other conditions, including Raynaud’s phenomenon, digital ulcers, and pulmonary hypertension.
A contributing factor is endothelial dysfunction, marked by arteries that are unable to relax and with time become constricted and narrowed, preventing normal blood flow. Endothelial dysfunction can also contribute to the abnormal activation of the immune response, triggering further inflammation and collagen production.
Statins may help protect the vascular system, as they can act directly on the endothelium, and reduce the symptoms of scleroderma-related conditions.
Some scleroderma patients may also have high cholesterol levels. Cholesterol can build up in arteries, causing them to narrow further, and trigger endothelial dysfunction. By lowering cholesterol levels, statins may improve blood flow in these patients.
There are many types of statins available. At least three statin medications have been investigated as potential scleroderma treatments to date: Lipitor (atorvastatin), Zocor (simvastatin), and Crestor (rosuvastatin).
Findings, to date, suggest effectiveness. For example, results of a randomized study comparing Lipitor to a placebo in 84 patients with systemic scleroderma, published in the Journal of Rheumatology, demonstrated that the treatment could be beneficial. The number of digital ulcers was significantly decreased, and the symptoms of Raynaud’s phenomenon were reduced in treated patients compared to those given placebo.
Side effects of statins
Common side effects of statins include nosebleeds, sore throat, runny or blocked nose, headaches, nausea, digestive system issues (including constipation, diarrhea, indigestion, or flatulence), muscle and joint pain, and high blood sugar.
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