Caring Medical - Where the world comes for ProlotherapyMy doctor says that my knee pain is being made worse by my elevated cholesterol

Elevated Cholesterol and Joint PainMarion Hauser, MS, RD

In this article, we will discuss the controversial and sometimes contradictory research in regard to cholesterol-lowering medication use in patients with knee osteoarthritis.

  • We will look at high cholesterol as a possible cause of knee pain and the effect of cholesterol-lowering medications to either alleviate symptoms or make the symptoms worse.

A question from email: “My doctor says that my knee pain is being made worse by my elevated cholesterol, I am being recommended to cholesterol-lowering medications. My doctor says that high cholesterol can cause inflammation in my joints. The medication will help.”

Evidence is unclear and controversial surrounding statin use for knee and joint pain

It is unclear who cholesterol-lowering medications can or cannot benefit. In our years of experience working with patients with knee pain we are sometimes asked  “do you recommend the use of cholesterol-lowering medications for knee pain?” Our answer is no. We do understand other health providers may feel differently.

An international team of university researchers and various national councils published these findings in the journal Arthritis care and research:

  • The research surrounding the possible relationship between statins use and outcomes in knee osteoarthritis is limited.
  • This study examined 1,127 adults for 4 years who took statins.
  • What the researchers were looking for was how did statin use influence:
    • Radiographic osteoarthritis, (how did the knee look in MRI and scans over the 4 year period. Did the MRI/scfans look worse?)
    • Symptomatic knee osteoarthritis (did the person in the study have new knee pain symptoms and was this matched by eroding conditions in the knee on MRI and scans?)
    • Overall, did the person’s knee pain get worse?


  • No matter what statin was used: Statin use was not associated with lower risk that the person’s pain would not worsen. Statins were not good pain medications.
  • Atorvastatin (Lipitor) use was associated with a reduced risk of developing pain, whilst rosuvastatin (Crestor) lead to a higher risk of developing pain.

From the researchers: “The effect of statins use on knee osteoarthritis outcomes remains unclear, although in our study those using statins for over five years and those using atorvastatin reported a significantly lower risk of developing knee pain.”

Confusing right?

  • If you already have knee pain, cholesterol lowering medicine will not help make it less painful or from it getting worse.
  • Cholesterol lowering medicine may help prevent a new knee pain symptom – but if you already have knee pain this is usually not much solace.

So again, all these research universities and national resources and a long-term study of over 1000 patients came to this conclusion in August 2018: “The effect of statins use on knee osteoarthritis outcomes remains unclear.”(1)

The story of cholesterol-lowering medications and joint pain surround the impact of these medications on inflammation

In our decades of experience, we have been able to harness the healing powers of inflammation into methods of regenerative medicine we describe as H3 Prolotherapy and its companion treatment Platelet Rich Plasma injections as well as stem cell therapy. Our research library is filled with articles about how inflammation heals and how inflammation destroys joints. For the purpose of this article, we will focus on the destructive elements of inflammation.

“The only significant finding indicated that increased duration of statin use was associated with worsening in knee pain and osteoarthritis.”

There is no general consensus that statins help or statins make things worse. I highlighted the study above because these were findings presented in August 2018. They are built on other research that took counter viewpoints.

A study from the Netherlands and a team of Dutch university researchers published in the Annals of the rheumatic diseases found that Statin use is associated with more than a 50% reduction in overall progression of osteoarthritis of the knee. (2)

Yet, Virginia Commonwealth University researchers published in the same journal the Annals of the rheumatic diseases, these findings:

  • Statin use was not associated with improvements in knee pain, function or structural progression trajectories.
  • The only significant finding indicated that increased duration of statin use was associated with worsening in knee pain and osteoarthritis. (3)

The doctors from the Netherlands responded in print a few months later in proper scientific debate. In this response in the Annals of the Rheumatic Diseases, it was suggested that parts of their study should be re-evaluated to find the benefits of statins. They point out

  • “Considering the theoretical effects of statins on osteoarthritis (lowering of serum lipid levels lowering local and systemic inflammation, and prevention of atherosclerosis), it is more plausible that statins could be useful in the early stages of osteoarthritis or even before initiation of the disease process.”(4)

If I control my cholesterol with diet and exercise, instead of medications, my knee pain can be helped without the medication’s side-effects.

Here medical and university researchers in China published their finding in the influential Scientific reports from the Nature Publish group in London.

  • In the present study of nearly 14,000 participants, the research team identified a positive association between hyperlipidemia and elevated risks of knee pain and clinical knee osteoarthritis in middle-aged or older adults.
  • There is a relationship between triglycerides and knee osteoarthritis.
  • Study results indicate that the influence of lipid-lowering drugs on knee pain and clinical knee osteoarthritis is limited.
  • These findings have notable implications for public health because the relatively high prevalence of knee osteoarthritis seriously affects the quality of life for older adults, and hyperlipidemia may be prevented through diet and physical exercise.

The Chinese team then sought to clarify the contradicting research presented in the two studies above.

  • The first study above from the Netherlands demonstrated that lipid-lowering drugs were associated with slower knee osteoarthritis progression.
  • The second study from Virginia did not find the same results
  • In this study from China, the researchers:
    • did not observe an increased risk of knee pain or clinical knee osteoarthritis among the group of participants without high cholesterol but taking lipid-lowering drugs for prevention of other diseases.
    • However, among participants with high cholesterol, risks for knee pain and clinical knee osteoarthritis were higher among those taking lipid-lowering drugs than among those not taking such drugs.
    • Possible explanations for this finding may be that the participants with hyperlipidemia and use of lipid-lowering drugs had higher serum lipids before pharmacotherapy and longer course of hyperlipidemia. Our results suggest that hyperlipidemia may be an independent risk factor for knee osteoarthritis and that the effect of lipid-lowering drugs on this association is limited.

The Chinese team concluded that their results indicate that hyperlipidemia may be an independent risk factor for knee pain and clinical knee osteoarthritis among middle-aged or older adults. These findings have substantial implications for the prevention of knee osteoarthritis through the reduction of blood lipid levels.(5)

If you have questions about your knee pain, you can get help and information from our Caring Medical Staff

1 Veronese N, Koyanagi A, Stubbs B, Cooper C, Guglielmi G, Rizzoli R, Schofield P, Punzi L, Al‐Daghri N, Smith L, Maggi S. Statin use and knee osteoarthritis outcomes: A longitudinal cohort study. Arthritis care & research. 2018 Aug 20. [Google Scholar]

2 Clockaerts S, Van Osch GJ, Bastiaansen-Jenniskens YM, Verhaar JA, Van Glabbeek F, Van Meurs JB, Kerkhof HJ, Hofman A, Stricker BC, Bierma-Zeinstra SM. Statin use is associated with reduced incidence and progression of knee osteoarthritis in the Rotterdam study. Annals of the rheumatic diseases. 2011 Oct 1:annrheumdis-2011. [Google Scholar]

3 Riddle DL, Moxley G, Dumenci L. Associations between statin use and changes in pain, function and structural progression: a longitudinal study of persons with knee osteoarthritis. Annals of the rheumatic diseases. 2013 Feb 1;72(2):196-203. [Google Scholar]

4 Clockaerts S, Van Osch GJ, Bierma-Zeinstra SM. Comment on ‘Associations between statin use and changes in pain, function and structural progression: a longitudinal study of persons with knee osteoarthritis’. Annals of the rheumatic diseases. 2013 May 1;72(5):e9-. [Google Scholar]

5 Zhou M, Guo Y, Wang D, Shi D, Li W, Liu Y, Yuan J, He M, Zhang X, Guo H, Wu T. The cross-sectional and longitudinal effect of hyperlipidemia on knee osteoarthritis: Results from the Dongfeng-Tongji cohort in China. Scientific Reports. 2017 Aug 29;7(1):9739.  [Google Scholar]

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