Statin-Induced Autoimmune Necrotizing Myopathy

Jayatilaka, Sahani; Desai, Kaushal; Rijal, Swarup Sharma; Zimmerman, Debra

doi:10.1177/21501327211028714

Cited by 10 publications

(4 citation statements)

References 18 publications

(12 reference statements)

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“…Such an approach could limit enthusiasm for participation in such a study. The potential for statins to cause autoimmune diseases ( 108 , 109 ) makes them a particularly dubious choice as therapy for TED. Several experimental studies suggest that lowering serum cholesterol levels, in and of themselves, may be ineffective in altering the development or activity/severity of autoimmune diseases such as TED ( 110 ).…”

Section: Deciphering the Pathogenesis Of Tedmentioning

confidence: 99%

Understanding Pathogenesis Intersects With Effective Treatment for Thyroid Eye Disease

Smith

2022

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Thyroid eye disease (TED), a vision-threatening and disfiguring autoimmune process, has thwarted our efforts to understand its pathogenesis and develop effective and safe treatments. Recent scientific advances have facilitated improved treatment options. Objective Review historically remote and recent advances in understanding TED. Design/Setting/Participants PubMed was scanned using search terms including thyroid-associated ophthalmopathy, thyroid eye disease, Graves’ orbitopathy, autoimmune thyroid disease, and orbital inflammation. Main outcome measures Strength of scientific evidence, size, scope, and controls of clinical trials/observations. Results Glucocorticoid steroids are widely prescribed systemic medical therapy. They can lessen inflammation-related manifestations of TED but fail to reliably reduce proptosis and diplopia, 2 major causes of morbidity. Other current therapies include mycophenolate, rituximab (anti-CD20 B cell-depleting monoclonal antibody), tocilizumab (interleukin-6 receptor antagonist), and teprotumumab (IGF-I receptor inhibitor). Several new therapeutic approaches have been proposed including targeting prostaglandin receptors, vascular endothelial growth factor, mTOR, and cholesterol pathways. Of potentially greater long-term importance are attempts to restore immune tolerance. Conclusion Despite their current wide use, steroids may no longer enjoy first-tier status for TED as more effective and better tolerated medical options become available. Multiple current and emerging therapies, the rationales for which are rooted in theoretical and experimental science, promise better options. These include teprotumumab, rituximab, and tocilizumab. Restoration of immune tolerance could ultimately become the most effective and safe medical management for TED.

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Section: Deciphering the Pathogenesis Of Tedmentioning

confidence: 99%

Understanding Pathogenesis Intersects With Effective Treatment for Thyroid Eye Disease

Smith

2022

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…The serological finding of anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase antibodies, through immunofluorescence or enzyme immunoassay tests, a finding of CK level >3000 IU/L, or a muscle biopsy that highlights the presence of muscle necrosis (without vasculitis, inflammation, or cellular infiltrates), indicates the presence of SINAM [8][9][10]. SINAM results in complaints of symmetrical weakness in the limbs, particularly in the lower limbs, weakness of the cervical muscles, and possible dysphagia (Figure 1) [11].…”

Section: Discussionmentioning

confidence: 99%

Immune-Mediated Myopathy in a Patient Presenting for Melanoma Resection and Sentinel Lymph Node Biopsy

Escher¹,

Hoffman²,

Alfieri³

et al. 2022

Cureus

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Statin-induced necrotizing autoimmune myopathy (SINAM) is a rare side effect in people who are taking a class of drugs called statins. Patients with SINAM will present with subacute severe symmetric proximal muscle weakness. In contrast to more common myopathies, SINAM may not spontaneously resolve with statin discontinuation. These patients may require long-term immunotherapy to limit further disease progression. In this case study, we report a 74-year-old female with SINAM who presented for radical excision of a right upper back melanoma and sentinel lymph node biopsy at an outpatient facility. An anesthetic plan was crafted with the use of a supraglottic airway device without neuromuscular blockade.

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“…In these genetically vulnerable people, statin exposure is thought to cause overexpression of HMGCR antibodies in regenerated myofibers. HMGCR and signal recognition particle (SRP) proteins, as well as classical pathway activation of complement proteins, were detected in the sarcolemma of muscle fibers in affected patients [ 7 ]. However, it is not studied whether this increased expression of HMGCR antibodies can be found without statin exposure.…”

Section: Discussionmentioning

confidence: 99%