Rouen, France - A new review published this week suggests that tendon impairments might be another side effect associated with the use of statins [1]. Published online February 29, 2008 in Arthritis & Rheumatism: Arthritis Care & Research, the review suggests that clinicians be aware of the possibility of tendon complications, including tendonitis and even tendon rupture, especially in patients who might be at higher risk of developing these side effects.

Those who might be at greater risk, write lead investigator Dr Isabelle Marie (Rouen University Hospital, France) and colleagues, include patients with metabolic disorders, patients who exert themselves physically throughout the day, and patients taking other drugs that might increase the toxicity of statins, such as steroids or antibiotics like fluoroquinolone.

The authors stress, however, that statin-associated tendon impairments are extremely rare, and none have been reported in pre- and postmarketing studies, including all the large statin trials. Anecdotal reports, however, have been described in the literature. With the anecdotal evidence in mind, the group retrospectively sought to identify all tendinous disorders attributable to statin therapy over a 15-year period. From 1990 to 2005, 96 spontaneous reports of tendon complications were reported to 31 French Pharmacovigilance Centers.

The average age of those who experienced problems was 56 years. The median time to onset of the side effect was 243 days, although complications arose in one patient within 24 hours of taking the statin. Nearly one-third of those experiencing tendon complications had an associated condition that favored the onset of tendon side effects, such as diabetes, hyperuricemia, and participation in sports.

The most common complication was tendonitis, followed by tendonitis with tendon rupture and de novo tendon rupture. Marie and colleagues note that complications were serious enough for 17 patients to report to a hospital, and 19 patients had significant functional difficulties, such as problems walking, decreased flexion, bruising, and pain.

The researchers write that the tendon disorders could be reasonably attributed to statin therapy because "there was a temporal relationship between onset of tendinous signs and the initiation of statin therapy." The problems cleared up or improved after stopping the drugs and recurred in seven patients who were restarted on statins.

The authors note that the side effects occurred with all the statins—atorvastatin, fluvastatin, pravastatin, rosuvastatin, and simvastatin—but that there is no known reason why the drugs might produce these injuries. Current French recommendations include tendon disorders on the list of adverse effects of statins, but future studies are needed to confirm the relationship and to determine the prevalence and incidence of statin-associated tendinopathy, conclude the group.