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Case Reports
. 2021 Feb 24:2021:8810754.
doi: 10.1155/2021/8810754. eCollection 2021.

Challenges in Treating Statin-Associated Necrotizing Myopathy

Patrick Webster  1 , Nicholas Wiemer  1 , Abdalhamid Al Harash  2 , Cody Marshall  3 , Nazia Khatoon  3 , Michael Lucke  2
Affiliations
Case Reports

Challenges in Treating Statin-Associated Necrotizing Myopathy

Patrick Webster et al. Case Rep Rheumatol. .

Abstract

Myalgia and mild elevation in muscle enzymes are common side effects of statin therapy. While these symptoms are generally self-limited, in rare cases, statin use is associated with an immune-mediated necrotizing myopathy caused by development of autoantibodies against HMG-CoA reductase. The primary presenting symptom of this condition is progressive symmetric proximal weakness that does not abate or worsens even after cessation of statin therapy and is associated with markedly elevated creatine kinase (CK) levels. To date, no randomized controlled trials have been conducted to identify the most effective treatment for statin-associated autoimmune myopathy. Treatment recommendations involve a combination of steroids and immunosuppressive drugs. This single-center case series highlights the clinicopathologic features diagnostic for statin-associated autoimmune myopathy as well as treatment challenges for the patient population. The series highlights a range of potential presentations, from mildly symptomatic despite highly elevated CK, to severe muscle weakness including dysphagia. Multiple patients required several immunosuppressant medications as well as intravenous immunoglobulin (IVIG) to achieve disease control. In this case series, marked improvement was noted in several diabetic patients with IVIG.

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Conflict of interest statement

The authors declare no conflicts of interest regarding publication of this article.

Figures

Figure 1
Figure 1
Regenerating (a) and degenerating (b) muscle fibers at 20x magnification.
Figure 2
Figure 2
MRI and STIR weighted sequences of the left femur showing extensive intramuscular edema.
Figure 3
Figure 3
Degenerating (a) and regenerating (b) muscle fibers at 400x magnification.
See this image and copyright information in PMC

References

    1. Parker B. A., Capizzi J. A., Grimaldi A. S., et al. Effect of statins on skeletal muscle function. Circulation. 20131;127(1):96–103. doi: 10.1161/circulationaha.112.136101. - DOI - PMC - PubMed
    1. Allenbach Y., Benveniste O., Stenzel W., Boyer O. Immune-mediated necrotizing myopathy: clinical features and pathogenesis. Nature Reviews Rheumatology. 2020;16(12):689–701. doi: 10.1038/s41584-020-00515-9. - DOI - PubMed
    1. Mammen A. Statin-associated autoimmune myopathy. New England Journal of Medicine. 2016;374 - PubMed
    1. Allenbach Y., Mammen A. L., Benveniste O., et al. Clinico-sero-pathological classification of immune-mediated necrotizing myopathies Zandvoort, the Netherlands. Neuromuscular Disorders. 2018;28(1):87–99. doi: 10.1016/j.nmd.2017.09.016. - DOI - PubMed
    1. Allenbach S., Lohani S., Tachamo N., Poudel D., Donato A. Statin-associated autoimmune myopathy. JCR: Journal of Clinical Rheumatology. 2017;23(3):149–154. doi: 10.1097/RHU.0000000000000497. - DOI - PubMed

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