Papel de las estatinas y su rol en los pacientes con LES.

Pregunta PICO
P: pacientes con LES
I: estatinas
C: mejor tratamiento disponible.
O: modificar curso de la enfermedad

¿ Cuál es el beneficio de estatinas en pacientes con LES ?

Artículos propuestos (para descargar el texto completo click sobre el título del artículo):
Titulo artículo Año y revista  publicación Comentarios Persona que lo propone
Effects of Rosuvastatin on Vascular Biomarkers and Carotid Atherosclerosis in Lupus: A Randomized, Double-Blind, Placebo-Controlled Trial 2011 Arthritis Care & Research Objective. To study the effect of rosuvastatin on vascular biomarkers and carotid intima-media thickness (IMT) in systemic lupus erythematosus (SLE).


Javier Cajas
Lupus Atherosclerosis Prevention Study (LAPS) 2011 Annals of the Rheumatic Diseases Cardiovascular disease is one of the major causes of death in systemic lupus erythematosus (SLE). A study was undertaken to investigate whether treatment with statins would reduce subclinical measures of atherosclerosis over a 2-year period Alex Casallas
Systemic Lupus Erythematosus in a Multiethnic US Cohort, LUMINA (XLIX) Preliminary Evaluation of the Impact of Statins on Disease Activity 2008 Journal of Clinical Rheumatology We have not been able to demonstrate that the use of statins is associated with lower levels of disease activity in our patients. Yet, increased production of interferon  and up-regulation of class II antigen expression are known to contribute to disease pathogenesis in both, humans and murine models of lupus; these mechanisms are modified by statins. Marvin Peña
Click acá para descargar el archivo comprimido con los articulos Varias Varios: Incluye APPLE study, APPLE study Suanalisis y otros. Diego Martinez
Do all lupus patients need statins? 2012 Joint Bone Spine Revisión Monica Bernal
Atorvastatin therapy improves endothelial-dependent vasodilation in patients with systemic lupus erythematosus: an 8 weeks controlled trial 2007 Rheumatology Objectives. To evaluate the efficacy of atorvastatin in improving vasodilation in SLE patients with and without conventional risk factors for coronary heart disease (CHD). Monica Bernal
Statin therapy reduces mortality and morbidity in systemic lupus erythematosus: a nationwide populationbased study in Taiwan 2013 Allergy Background: Statins possess diverse immune modulatory and anti-inflammatory properties. Statins may reduce atherosclerosis and cardiovascular morbidity in the general population, but the effect on patients with systemic lupus erythematosus (SLE) was not clear. The purpose of this study was to evaluate the association between statin use and the risk of developing end-stage renal disease (ESRD), coronary artery disease (CAD), and mortality in a cohort of patients with SLE. Yimy Medina
Influence of atorvastatin on coronary calcifications and myocardial perfusion defects in systemic lupus erythematosus patients: a prospective, randomized, double-masked, placebo-controlled study 2011 Arthritis Research & Therapy Mortality in systemic lupus erythematosus (SLE) patients is influenced by an increased occurrence of severe cardiovascular complications. Statins have been proven to protect a wide spectrum of SLE patients from these complications. This study was conducted to determine the possible efficacy of atorvastatin in SLE patients as assessed by multi-detector computed tomography (MDCT)-based coronary calcium scoring and single photon emission computed tomography (SPECT) of the myocardium. Diana Isabel Mora Guevara
Cardiovascular disease in lupus patients: Should all patients be treated with statins and aspirin? 2005 Best Practice & Research Clinical Rheumatology Premature coronary heart disease (CHD) is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). In certain age groups, the risk can be O50 times that of an age-matched population. This population also has an increased prevalence of several key classic risk factors that contribute to the CHD development. Chronic inflammation, anti-phospholipid antibodies and exposure to steroid therapy are also likely to have an impact. We have adopted a proactive approach to classic risk factor management with ‘ideal targets’ based on viewing SLE as a CHD equivalent condition. Luis Alejandro Satizábal Bernal
Use of Atorvastatin in Systemic Lupus Erythematosus in Children and Adolescents 2012 Arthritis Rheum Statins reduce atherosclerosis and cardiovascular morbidity in the general population, but their efficacy and safety in children and adolescents with systemic lupus erythematosus (SLE) are unknown. This study was undertaken to determine the 3-year efficacy and safety of atorvastatin in preventing subclinical atherosclerosis progression in pediatric-onset SLE. Mauricio Arias Franco
Atorvastatin effect on systemic lupus erythematosus disease activity: a double-blind randomized clinical trial 2014 Clin Rheumatol We aimed to evaluate the therapeutic effects of atorvastatin on systemic lupus erythematosus disease activity index (SLEDAI). Ninety patients with SLE were consented and randomized to receive either atorvastatin, 20 mg/day, or placebo for 3 months. The primary outcome was change in SLEDAI. Jainer Méndez Flórez
Statin therapy in lupus-mediated atherogenesis: two birds with one stone? 2011 Ann Rheum Dis. The atherosclerotic process is accelerated in patients with systemic lupus erythematosus (SLE). In addition to a robust lipid-lowering effect, various immunomodulatory functions have been ascribed to statins. By virtue of the latter they may be able to reduce atherosclerotic vascular disease in SLE by inhibiting immune activation within the arterial wall and by attenuating lupus activity. The effects of statins on SLE as well as on lupus-mediated atherogenesis in vivo are discussed in this viewpoint. Jainer Méndez Flórez

1. Resolver dudas acerca de puntos específicos o situaciones clínicas particulares en reumatología.
2. Formular la inquietud clínica mediante la metodología de pregunta PICOT (población, intervención y su comparador, Outcome del idioma inglés desenlace, y si es pertinente tiempo para llegar al desenlace.
3. Ejercitar el ejercicio investigativo mediante búsqueda de la literatura en las bases de datos disponibles.
4. Lectura dela literatura, síntesis y desarrollo del tema de acuerdo a la pregunta planteada.
5. Discusión de los conceptos adquiridos en la lectura de los artículos y llegar a una conclusión consensuada.

Dinámica del seminario:
1. Formulación del interrogante clínico como pregunta PICOT
2. Búsqueda de la literatura de los artículos que lleven a responder la pregunta por parte de cada uno de los integrantes.
3. Enviar los artículos encontrados a los demás integrantes del seminario (docente y residentes, etc.). Cada uno de los integrantes realiza su propia búsqueda de acuerdo a la pregunta clínica y envía a los demás su artículo.
4. Lectura y apreciación crítica de la literatura encontrada y recibida.
5. Discusión de los conocimientos adquiridos con los otros miembros del seminario.

Aspectos para la evaluación del estudiante:
1. La formulación de la pregunta clínica y la forma de realizarla en formato PICOT
2. Búsqueda de la literatura encontrada y enviada a los demás integrantes. Se tendrá en cuenta los artículos enviados por cada estudiante. Cuando un artículo enviado sea repetido con los de los otros integrantes, se tendrá en cuenta el artículo del estudiante que primero lo haya enviado.
3. En caso de que el estudiante no encuentre literatura debe enviar la historia de la búsqueda, el pantallazo de la búsqueda y los términos usados en la búsqueda.
4. La discusión del tema durante el seminario y el aporte que se dé a la discusión con el soporte correspondiente basado en los artículos leídos.

Herramientas y recursos: