PITAVASTATIN IN THE MANAGEMENT OF RHEUMATOID ARTHRITIS

Sudhananthini Thangam, Revathi Pitchaipillai*, JeganArokiasamy, Chinthana Govindarajan, Bhuvaneswari Shanmugasundaram, Manickavasagam Subramania Pillai

ABSTRACT

Rheumatoid Arthritis (RA) is an auto-immune disease predominately affects synovial joints. The clinical hallmark of RA is inflammation of peripheral joints - typically in the hands (metacarpophalangeal joints and proximal interphalangeal joints), causing pain, stiffness and often some degree of irreversible joint damage, deformity and disability. RA can also affect various organs and organ systems including skin, lungs, heart, kidney, nervous system and gastrointestinal tract. Worldwide prevalence of RA was recorded from the range between 2.0 to 10.7 per 1,000 based on the 1987 revised American College of Rheumatology (ACR) criteria. In INDIA, the prevalence is found to be approximately 0.75%. Classification as definite RA is based on the joint American College of Rheumatology (ACR) and the European League against Rheumatism (EULAR) criteria. The management of RA involves the use of Symptom modifying anti rheumatoid drugs (SMARDs) like Non steroidal anti-inflammatory drugs, glucocorticoids and Disease modifying anti rheumatoid drugs (DMARDs) like Methotrexate, Sulphasalazine etc. Statins, introduced to the market as lipid-lowering agents, have been shown to reduce cardiovascular morbidity and mortality. Various trials with statins on RA like TARA trial have proved their efficacy in the management and prevention of risk factors in RA. Pitavastatin, the seventh statin is a new member of the statin family. Being a lipophilic statin it can easily penetrate hepatic and extrahepatic tissues like bone and exert its anti-inflammatory effect. It is proved to be efficacious compared to other statins based on Patrol trial, Lives study and Chiba study. Many studies demonstrated that pitavastatin increases bone resorption in RA. Pitavastatin is proved to be a more safer and efficient adjuvant drug in the management of RA along with DMARDs, particularly in elderly patients.

Keywords: Rheumatoid Arthritis, Statins, Pitavastatin, Synovitis, Inflammation.