Doctors love statins-type cholesterol-lowering medications. The # 1 most prescribed drug in the US is atorvastatin! At last count 28 million people take this drug daily. Rosuvastatin gets nearly 10 million people. Add in simvastatin (7 million), pravastatin (4 million) and lovastatin (1.4 million) and you get 50 million Americans on a statin. For reasons that we don’t understand, many physicians do not like hearing about statin side effects. We have been especially puzzled that any connection between joint pain and atorvastatin (or any other statin for that matter) seems to be rejected.
A Question That Opened a Statin Search Into Joint Pain:
Q. You answered a question in your column from someone who complained about arthritis. I think you missed an important point. The reader asked about the pain medication naproxen (Aleve) for his joint pain.
You ignored the fact that he was on a high dose of atorvastatin (80 mg). His joint pain might be due to the statin.
He should be advised to speak to his cardiologist. I am a cardiac nurse and I have seen many patients get relief from muscle and joint pain simply by switching statins.
The Original Question re: Joint Pain and Atorvastatin
A. Thank you for reminding us that some people are especially susceptible to statins and experience both muscle and joint pain. The individual who contacted us had a heart stent and was taking 80 mg of atorvastatin along with carvedilol, ramipril and aspirin.
He had developed joint pain in his knees and a shoulder and had not had much success with celecoxib (Celebrex) or acetaminophen (Tylenol). He wanted to know if Aleve would be safe with his other medications.
The Danger of NSAIDs for Heart Patients:
Except for aspirin, non steroidal anti-inflammatory drugs like diclofenac (Voltaren), naproxen or ibuprofen (Advil, Motrin IB, etc) can be dangerous for people with heart disease. For one thing, they can raise blood pressure. For another, they can increase the risk of heart attacks and heart failure (Current Cardiology Reports, March, 2016).
We suggested that NSAIDs might be a bad choice with someone who had diagnosed heart disease and a stent and recommended non-drug approaches for joint pain such as ginger, boswellia, turmeric, cherry and grape juice along with gin-soaked raisins (details in our eGuide to Alternatives for Arthritis).
Joint Pain and Atorvastatin: Really?
We are ashamed to admit that we did not consider a relationship between the person’s joint pain and atorvastatin (80 mg). That’s because joint pain is rarely mentioned as a side effect in the clinical trials. Most people complain about muscle pain and weakness while taking drugs like atorvastatin, lovastatin, pravastatin, rosuvastatin or simvastatin.
But when you look carefully in the official prescribing information you will discover a relationship between joint pain and atorvastatin. The same holds true for other statin-type cholesterol-lowering drugs. It may be described as “arthralgia” rather than arthritis or joint pain, but we’re basically talking about the same problem.
Most physicians probably have not heard about a connection between joint pain and atorvastatin. That’s why they are likely to dismiss such patient complaints. But if you look at the official prescribing information for atorvastatin, this is what you will find:
“The most commonly reported adverse reactions (incidence ≥ 2% and greater than placebo) regardless of causality, in patients treated with atorvastatin in placebo controlled trials (n=8,755) were: nasopharyngitis (8.3%), arthralgia (6.9%), diarrhea (6.8%), pain in extremity (6.0%), and urinary tract infection (5.7%).”
In other words, arthritis-like symptoms are among the most common adverse reactions reported in clinical trials. 11.7% of patients getting the 20 mg dose of atorvastatin reported “arthralgia.”
Readers Share Stories of Joint Pain and Atorvastatin:
Holly reported:
“I went through many months of debilitating unexplained leg, knee and foot pain. I had some hip problem before starting the statin (atorvastatin), but this also got much worse. It would get so bad that just getting up out of a chair would be excruciating. I would have to stand there like 5 minutes just to prepare myself to take the first few steps.
“I was using a cane and wearing a knee brace. I had deep throbbing pain in my big toe, burning tearing pain down my IT band. My orthopedic doc found some minor arthritis, but nothing to explain this level of pain. I was taking gobs of painkillers, trying soaking in epsom salt, foam roller, orthotics in my shoes….I was going to a chiropractor for therapy, which helped minimally, but I think the effects of the statin finally wore off.
“I had taken them for a few months when all this started, I quit for 2 weeks, but still had the pain, so my doc said the statin couldn’t be the cause. I started taking atorvastatin again but things continued to get worse. I quit again on my own.
“After I was off statins for about 4 months things started to really turn around for me. I feel so much better now. I cannot believe the difference. I was beginning to feel totally hopeless. Nothing was improving at all and the pain made no sense! I think the docs thought I was crazy.”
We never encourage anyone to stop a prescribed medicine without careful consultation with the prescriber. That said, this is not the first person who discovered that pain disappeared after cutting back on a statin.
It’s Not Just Joint Pain and Atorvastatin. Pravastatin and Arthritis:
Q. I was diagnosed with rheumatoid arthritis several years ago and was prescribed the powerful prescription drugs Enbrel and methotrexate. I continued these meds for over a decade. Sometimes my doctor would add cortisone injections in sore joints.
I saw an article on statin side effects and stopped pravastatin to see if it made a difference. My “rheumatoid arthritis” magically disappeared.
A. Thank you for sharing your interesting experience. We found one study linking statin use to the risk of rheumatoid arthritis (Annals of the Rheumatic Diseases, May, 2012). More recent reviews of the medical literature report no such association (PLoS One, July 23, 2024). There is even some research to suggest that the anti-inflammatory activity of statins might be helpful.
Statins, including pravastatin, can cause symptoms of arthritis and increase levels of antinuclear antibodies (ANA). Doctors use this as a marker for autoimmune diseases including rheumatoid arthritis. That may help explain your misdiagnosis and recovery after stopping statins.
Other Readers Report Joint Pain and Atorvastatin
Victoria notes:
“I have taken atorvastatin for three or four years without much change in my cholesterol values. Two weeks ago I started to have severe muscle spasms in my legs. Last night they woke me 7 times. My arthritis has flared up over the last six months. I have some memory changes recently along with nerve pain in my foot.”
Many health professionals might suggest that the muscle spasms and arthritis pain are unrelated to atorvastatin, but we have heard this story many other times.
Natalie reports:
“I started taking atorvastatin at the age of 64. My cholesterol was 243 and now it is 150. I’ve worked out in the gym since high school so I consider myself to be in great shape.
“Recently, my hips started hurting…a lot. I have had to change position in bed every two hours or so which makes for a restless night. I have told myself that I am getting older and probably overdid it at the gym, but now I am not so sure. Last week I went to a hand specialist for wrist pain. After looking at the x-ray my doctor said it was arthritis and gave me a cortisone shot. The shot helped. Now I think I need shots in my hips. I have been diagnosed with arthritis in my knees some years ago after knee surgery, but ironically, my knees don’t hurt.”
Abby is a doctor who now thinks there is a link between statins and arthritis:
“I’m a physician. I was on atorvastatin for a few years and used to getting tendinitis. I never made the link. Then I got erosive arthritis in the wrist. It was very severe indeed.
“I then read about the possible connection between statins and arthritis in The Lancet. My cardiologist advised reduction in dose, but it was not until I stopped atorvastatin altogether that gradually the joint improved. So far so good.”
What Should a Heart Patient Do About Joint Pain and Atorvastatin?
We agree with the cardiac nurse that the cardiologist might want to reevaluate his prescription for atorvastatin. For one thing, 80 mg is a high dose. Perhaps a different statin at a lower dose would have benefits without side effects.
For those who cannot tolerate any statins, we offer our eGuide to Cholesterol Control and Heart Health, in which we discuss other ways to reduce the risk of heart attacks.
Share Your Story:
Have you ever experienced side effects on a statin or are you resistant to complications? Please share your story below in the comment section. We would also appreciate a vote on this article at the top of the page. And if you know people who are taking a statin-type medicine you might want to share this article with them. No one should ever stop a medications without first checking with the prescribing health professional.
