2017
DOI: 10.1097/rhu.0000000000000497
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Statin-Associated Autoimmune Myopathy

Abstract: Statin-associated necrotizing myopathy is a symmetric proximal muscle weakness associated with extreme elevations of CK. It is common in males and can occur after months of statin use. It is associated with necrosis on muscle biopsy and the presence of anti-HMG-CoA reductase antibodies. It usually requires discontinuation and immune suppression for resolution. Rechallenge with statin is unsuccessful in most cases.

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Cited by 78 publications
(74 citation statements)
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“…Affected patients show progressive proximal muscle weakness involving both limb girdles, CK values between 10 and 100 times the upper limit (2000 and 20,000 IU/L), myopathic electromyography findings, and muscle biopsy usually showing necrosis with regeneration of muscle fibers and scarce inflammation, mainly composed of macrophages [24,25]. Certain immune-mediated features, such as endothelial membrane attack complex (MAC) deposition in non-necrotic fibers and MHC class I expression are additional pathologic features of this condition (Figure 1).…”
Section: Defining Clinical Phenotypesmentioning
confidence: 99%
“…Affected patients show progressive proximal muscle weakness involving both limb girdles, CK values between 10 and 100 times the upper limit (2000 and 20,000 IU/L), myopathic electromyography findings, and muscle biopsy usually showing necrosis with regeneration of muscle fibers and scarce inflammation, mainly composed of macrophages [24,25]. Certain immune-mediated features, such as endothelial membrane attack complex (MAC) deposition in non-necrotic fibers and MHC class I expression are additional pathologic features of this condition (Figure 1).…”
Section: Defining Clinical Phenotypesmentioning
confidence: 99%
“…Often times, the presenting symptoms mimicked other more common autoimmune myopathies such as polymyositis [11]. A systematic literature review of 100 SINAM cases by Nazir et al found that the mean duration of statin use prior to the onset of myopathy symptoms was 40.48 months, which is much longer than our patient's presentation after only one month of use [12]. Treatment outcomes for SINAM patients were favorable, with 91% of patients having a complete resolution of symptoms.…”
Section: Discussionmentioning
confidence: 56%
“…As compared to statin-associated myopathy where CK is in hundreds, CK in NAM is usually in thousands. 7 EMG studies show abnormalities consistent with the irritable myopathic process. Muscle biopsy remains the gold standard for diagnosis, and histopathologic findings show presence of necrotic and regenerative myofibers.…”
Section: Discussionmentioning
confidence: 90%
“…3 Affected patients have been advised against the use of statin in future life as continuation has been found to be associated with worse outcomes. 7 Moreover no significant differences in disease severity, outcomes, and response to therapy have been found among the different etiologic groups. Overall, the mortality in patients with IIM remains 2- to 3-fold higher than the general population, with cardiac, lung complications, cancer, and lung infections being the most common causes of deaths.…”
Section: Discussionmentioning
confidence: 98%