Let's shake things up a bit!

General
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Quoting the venerable tntlamb, on another thread:

Do the beta blockers and Statins sound familiar??? I can’t begin to tell you what nasty meds those two are for PsA patients.

You can’t begin to tell us? Really? C’mon, give it a go …

Statins and beta blockers are meds that a lot of us (and the general population) take. What makes them so nasty for us?

I’m particularly interested in statins: my doctor is trying hard to get me to take them. I’ve recently relented after years of resisting. I’ve just quit my second statin because of intolerable side effects. I take loads of medications, and I rarely have SEs, but oh, these statins …

So what the “special relationship” that we PsA-ers have with these drugs?

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Interesting question!! I’m not sure how the relationship fits with PsA, only because I have limited knowledge of that connection.

What I can say though is that I have had trouble with statin side effects in the past, so although I have a supply here of another one to try, I really am reluctant to add it to my current daily “pick’n’mix” bag of meds lol. Needless to say I too would be keen to hear others experiences with them.

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Interesting one Seenie. My husband refuses to take statins despite having had a stroke 20 years ago. He just has daily aspirin. I don’t know whether he’s right or wrong.

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I wonder if @tntlamb will have something to say, or whether he’s to busy to let himself get started … :thinking:

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Well having had a stroke, we spent a lot of time making sure it wasn’t related to Cholesterol levels as the post stroke protocol calls for a pretty heavy dose of statins which is tapered down over time. MOST respond very quickly.

Here is the issue with statins. The most common side effect is Muscle pain and weakness. This effect is often downplayed as either temporary and will pass within a few weeks after stopping the meds. Some docs even say the effect is worth it because of the lower risk of heart attack/stroke.

Perhaps this is true for patients who do not have connective tissue disease (like we do) but I’m not sure. For us I don’t believe it is.

Heres why. Statins work specifically because statins activate the gene atrogin-1 gene, which plays a key role in muscle atrophy This damage is often permanent, Then the mechanism further works by inhibiting an enzyme in your liver that’s needed to manufacture cholesterol. The problem is for US cholesterol is our friend.

It’s an integral part of your cell membranes, and it’s also the precursor (the raw material) your body uses to make your steroid hormones – one of which is vitamin D. Your skin contains cholesterol, and when UVB rays from the sun hits your skin it converts that form of cholesterol to vitamin D3, which is then transported to your blood. Your body then further converts it into the active form of vitamin D.

Further, the major reasons your body makes cholesterol in the first place, and why you have LDL (the so-called “bad” cholesterol), is to take the cholesterol to the tissue so you can make new cells or repair old damaged ones – an extremely important process.

Pretty important stuff I would say.

THEN it gets bad REALLY BAD. This recent study confirms it. Glucocorticoids (GC) are a frontline therapy Arthrits because of their demonstrated efficacy at reducing systemic inflammation. An unintended side effect of GC therapy is the stimulation of skeletal muscle atrophy. So if you are using any measure of steroids, along with statins, you run really increase the chances of damaging muscles and connective tissue…

BUT WAIT it gets worse… The breakdown of skeletal muscle tissue leads to kidney failure. So If you have Arthritis you are taking, Steroids (at some point,) DMARDS, Biologics all of which effect the kidneys Add atrogin-1 gene from the statins, and it isn’t a matter of if your kidneys screw you up, its a matter of when.

Like my cardiologist says you have two 80 year olds walking down a hall when is up right walking normally and is considered “Young” for his age. the other bent over, shuffeling and looking pretty darn old what is the difference? The difference is Kidney function.

75 percent of your cholesterol is produced by your liver, (not your diet) which is influenced by your insulin levels. Therefore, if you optimize your insulin levels, you will also regulate your cholesterol levels. I can’t stress how important exercise AND a low carbohydrate glycemic diet is. I have heard it said that EVERY arthritis patien shoul eat and exercise as if they had diabetes, if they don’t have it now, they will (because of all the above)

Now I’m not saying there is no place for statins. I’m sure there are. High cholesterol is only PART of the reason. Yes above 330 is high but unless there is a genetic reason/history, Statins should be the very LAST resort. Even if cholesterol is high, one should look at their HDL ratio Simply divide your HDL level by your cholesterol. That percentage should ideally be above 25 percent. Typically, the higher the better, as there are no known side effects of having too high good cholesterol.

If your ratio falls below 15-20 percent you are at high risk, and below 10 percent, it’s a significant indicator of risk for heart disease.

One other thing I think is important Statins deplete your body of Coenzyme Q10 (CoQ10), which is beneficial to heart health and muscle function. This depletion leads to fatigue, muscle weakness, soreness and eventually heart failure. There is little evidence that supplementation has much effect (not to mention CoQ10 supplements are really expensive) There is some evidence that a product called ubiquinol is better absorbed and may have more effect than regular Qq0 (talk to your doc…

Here is the “number” that scares me about Statins: One recent study (more need done before its “fact”) shows the viability of proliferating cells was reduced by 50 percent at a dose equivalent to 40 milligrams of Simvastatin – the dose per day used in some patients. This could clearly have a negative effect on your skeletal muscles’ ability to heal and repair themselves, and could lead to eventually becoming more or less incapacitated.

So here is what I did (under the direction of a top 100 Cardiologist) who after more studies than I care to list determine my stroke was as the resul of Atrial Fib, common with PsA. following my stroke Jan. I did take the short course of high dose Stains (less than 2 weeks) along with a baby aspirin a day THEN we started an actual anti coagulation routine - Xarelto. A Beta Blocker (bystolic) , and a couple of "water pills (calcium channel) They quit the statins VERY quickly.

In addition the nutritionist (and wife) worked me over pretty good on diet. Basically its a very low carb diet) The PT has me on a treadmill 30 minutes a day. The Rheumy cut me off Predi for the most part (increased the MTX.) Since then I have lost about 50 pounds. My blood sugar is great, cholesterol is perfect and actually I feel better than I have in a while.

The main issues with Beta Blockers is fatigue and depression. There are dozens of Beta blockers however. SOME when mixed with arthritis drugs actually increase blood plasma levels which dramatically increase symptoms. One jsut need be very careful in choosing./ One good side effect however is they do decrease anxiety…

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Oh boy. Well, I asked for it. :thinking: I hope you’re not giving us a pop quiz on that!

What this says to me is that those of us with PsA should accept statins very reluctantly and carefully, and avoid them if we at all can. Have I got that right?

Interesting, several years ago (before I was diagnosed, but I was plenty symptomatic, with PsA) my GP was urging me to take a statin. (Having a tantrum about it would be a better description.) My problem was not high cholesterol: it was low HDL, which I now gather is the handiwork of our old foe PsA. I pursed my lips and blurted “Don’t worry, I’ll fix it myself”. Three months later, I went back for blood work and she was grudgingly impressed. My HDL had risen just enough to get The Ratio into the OK zone. What had I done? A very low carb diet.

My mother went on a statin in her seventies. She hated the aches, but said the doctor said it was worth the pain, something that she accepted but of which I was skeptical. It seemed to me that she aged really quickly after that, and I thought it was the statin. But who knows how she would have been without the statin? The same, quite possibly, but who knows. In her eighties, she got atrial fibrillation, which seemed a bit odd seeing we had nobody else in the family with any kind of a heart issue. It was only when my disease was investigated by a top-drawer PsA researcher that we realized that my mother had almost certainly had PsA too.

I also have to admit to a skepticism about a type of medication prescribed for statistical purposes, which can be problematic for some people, and very problematic for others, but which is reliably profitable for the drug companies.

Maybe it’s time to get serious about kicking the carbs to the curb again. (Not that I’m a carb pig, but I eat a “normal” health diet with 4-6 servings of carbs a day.) Then again, I hate beating my kidneys up with waste products of of a high-protein, low carb diet.

Oh, what to do? I just can’t win. Except in the PsA lottery.

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@tntlamb, thank you soo much for the detailed explanation… I’m not too sure I have absorbed it all (lol), but I feel you have generally answered the reason for my “instinctive” reluctance to go back to the statins.

I had a small stroke (Dec 2015, aged 54) that has left me with a visual field impairment, just sufficient to prevent me from driving, I must clarify that it was only my vision that was affected and I feel very lucky to have had no other disabilities from it. After the stroke I was, as per the norm, put on statins… I think it was about a week later that the muscles in my butt started to sting (I believe this is a sign of muscle atrophy, or similar) and the statins had to be stopped immediately (hence my reluctance to try again, even with a different statin).

At the time of my stroke (which is thought to have been caused by a mal-formed vertebral artery, so could have happened anytime I guess) my cholesterol levels were only marginally high, and I was not taking medication for anything.

Since the current flare (which seems to started in March 2016) my cholesterol levels appear to have sky rocketed to a point where they cannot be calculated accurately in blood tests (well that’s my understanding of the results), and I have felt that perhaps it was the inflammation that was increasing the cholesterol levels and if so, perhaps, cholesterol levels may be a better guide to inflammation levels than CRP or ESR for those of us in who these tests remain within normal ranges. Purely my thoughts, and definitely NOT based on any research!!!

Still I remain off the statins (perhaps foolishly) but do religiously take “blood thinners” and blood pressure meds (in low doses), in an effort to reduce the risk of another stroke.

Thank you once again tntlamb!! I am sure I would not be the only one to say your input on this forum is invaluable, and so very much appreciated!!!

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That’s an interesting thought. Given the job of cholesterol in the first place it makes a lot of sense…That will keep me busy for a while!

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Sorry!!! Didn’t mean to add to your already heavy work load!!! I would be very keen to hear what you can find out though.
There is too much conflicting information out there for my sorry little brain to process lol

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TNT, I had that experience too. I often have wildly fluctuating cholesterol levels, initially I assumed it was fluctuating absorption (from my bowel issues), but it doesn’t seem to correlate. I’ll be watching them now to see if there’s a correlation with PsA flares…

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Oh my! Something else I need to churn over now. I was put on atorvastatin and bisoprolol (beta blocker) last year after cardiac catheter. I have a diagnosis of left bundle branch block which I understand is a conduction defect. It was a new problem - I was investigated after becoming unwell on sulfasalazine.

Previously during MRI scan of the brain when I was being investigated for pain, an incidental finding was made of 'bright areas consistent with age related ischaemic incidents". I was 47 and had no symptoms of mini strokes.

My father had an MI at the age of 45 and he was a tall, slim and fit man. He was, however, a smoker. I’ve never smoked. I have raised cholesterol. Overall it was felt by doctors that I am at risk, hence the statin.

The bisoprolol is because the heart block leaves me breathless without some effort to control it to the extent that I cannot speak in full sentences.

I know I need the beta blocker but now I’m not so sure if the statin is a good idea?

I just try to be compliant. It was a cardiologist who started me on those meds, and my rheumatologist is aware but hasn’t raised any of this :roll_eyes:

I am already vit d3 deficient and have low platelets, but that was before any of these rheumatology or cardiology medications.
Don’t really know what to think but it will be a topic at my next review for certain!

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A bundle branch block is an early indication of Hypertrophic cardiomyopathy which is a common complication of PsA (60% of women) While it usually isn’t a big problem as it usually involves a right bundler branch block and usually develops slowly… When it involves the left ventricle (which a left Bundle Branch Block does it needs watched and treated aggresivley. ABSOLUTLEY you need whats been prescribed You also need an echo cardiogram 2 - 4 times a year Period.

Just about everybody who is your age or has headaches has those “white spots” they are also common with autoimmune disease. Its not something I’d lose sleep over, but certainly be aware of.

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That sounds good advice @tntlamb - I’ve not been recalled for an ECG, and my cardiac cath was a year ago. I will get in touch with my doc. Thank you so much.

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