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Statin induced necrotizing autoimmune myopathy is a rare side effect and requires immunosuppressive therapy. Persistence of proximal muscle weakness and elevated creatine kinase level despite statin discontinuation, muscle necrosis and elevated anti-HMGCR (3-hydroxy 3-methyl glutaryl coenzyme A reductase) autoantibodies are distinguishing features from other statin related musculoskeletal side effects. In this report, a case using statin and diagnosed with autoimmune necrotizing myopathy is presented.

BackgroundBiologic therapies have led to a dramatic change in the management of rheumatologic diseases. Although biologic agents provide profound clinical benefits, various adverse events are associated with their use particularly an increased risk of the reactivation of latent tuberculosis. Therefore, screening for latent tuberculosis infection (LTBI) is imperative before initiating biologic agents1. Although tuberculin skin test (TST) is the most common test for detecting LTBI, Bacillus Calmette-Gue'rin (BCG) vaccination and non-tuberculosis Mycobacterium infections, can lead to false positive TST results. Interferon-gamma release assay (IGRA) measures the immune response to tuberculosis specific antigens that do not cross react with BCG, and therefore, do not cause false positive reactions in BCG recipients. Its positiveness indicates the presence of tuberculosis infection either latent or active2.ObjectivesWe aimed to prevent the unnecessary anti-tuberculosis prophylaxis in patients whom biologic therapy is planned by evaluating the concordance between the TST and IGRA.MethodsPatients who have been receiving biologic therapy due to chronic inflammatory arthritis were enrolled in this study. Demographic and clinical data, TST and IGRA results were recorded. The agreement between IGRA and TST results was evaluated by Kappa coefficient.ResultsA total of 35 patients were included; 15 (42.8%) were male and mean age was 43.74±12.72 years. Of the 22 TST positive patients, 13 (37.1%) were IGRA negative. Of the 13 TST negative patients, 3 (8.6%) were IGRA positive. Nine (25.7%) patients were positive for either of the two tests and 10 (28.6%) patients were negative for both tests. There was statistically significant discordance between two tests (p:0.021; p<0.05) (Table 1). While positive rate of TST was 62.9%, positive rate of IGRA was 34.3% and Kappa consistency coefficient between two tests was 15.4% (p:0.283; p>0.05).Table 1.Agreement between IGRA and TST resultsIGRATSTTotalp Negative n (%)Positive n (%)n (%) Negative10 (28.6)13 (37.1)23 (65.7) 0.021 Positive3 (8.6)9 (25.7)12 (34.3)Total13 (37.1)22 (62.9)ConclusionsIt is very common in rheumatology practice to administer anti-tuberculosis prophylaxis according to the TST. IGRA may reduce the number of patients in whom tuberculostatics are prescribed, especially in BCG recipients in endemic populations, resulting in a benefit of avoiding possible side effects. Furthermore, IGRA is also important for detecting the cases of LTBI that would be missed by TST. Confirmation in larger studies is necessary.References Costantino F, de Carvalho Bittencourt M, Rat AC, et al. Screening for latent tuberculosis infection in patients with chronic inflammatory arthritis: discrepancies between tuberculin skin test and interferon-γ release assay results. J Rheumatol. 2013 Dec;40(12):1986–93.Ruan Q, Zhang S, Ai J, et al. Screening of latent tuberculosis infection by interferon-γ release assays in rheumatic patients: a systemic review and meta-analysis. Clin Rheumatol. 2016 Feb;35(2)...

Objective: The aim of this study was to determine the effects of teriparatide treatment on bone mineral density (BMD), back pain, and biochemical parameters in patients with severe postmenopausal osteoporosis. Materials and Methods:The study included 13 patients with severe postmenopausal osteoporosis who were followed up at our osteoporosis outpatient clinic and completed treatment or currently undergoing treatment with subcutaneous 20 μq/day teriparatide. Patients were retrospectively evaluated before and after treatment with regards to BMD, biochemical parameters, and severity of back pain. Results: When the pre and post treatment values of the patients included in the study were compared, there was a statistically significant improvement in the BMD and severity of back pain after treatment (p<0.05), while the biochemical parameters did not differ significantly (p>0.05). Conclusion: In patients with severe postmenopausal osteoporosis, teriparatide therapy is seemed to be an effective treatment choice by improving the BMD values and reducing the back pain.Amaç: Bu çalışmanın amacı, şiddetli postmenopozal osteoporozu olan hastalarda teriparatid tedavisinin kemik mineral yoğunluğu (KMY), sırt ağrısı ve biyokimyasal parametreler üzerine etkisini belirlemektir. Gereç ve Yöntem: Çalışmaya osteoporoz polikliniğimizde takip edilen, subkütan 20 μq/gün teriparatid tedavisi alan, tedaviyi tamamlamış veya halen tedavi gören 13 şiddetli postmenopozal osteoporoz hastası dahil edildi. Hastalar tedavi öncesi ve sonrası KMY, biyokimyasal ve sırt ağrısının şiddeti bakımından retrospektif olarak değerlendirildi. Bulgular: Çalışmaya alınan hastaların tedavi öncesi ve sonrası değerleri karşılaştırıldığında, tedavi sonrası KMY ve sırt ağrısı şiddeti açısından istatistiksel olarak anlamlı iyileşme saptanırken (p<0,05) biyokimyasal parametreler anlamlı düzeyde farklılık göstermedi (p>0,05). Sonuç: Şiddetli postmenopozal osteoporozu bulunan hastalarda teriparatid, KMY değerlerinde düzelme ve sırt ağrısında azalma sağlayarak etkili bir tedavi seçeneği olarak görülmektedir. Anahtar kelimeler: Sırt ağrısı, şiddetli osteoporoz, teriparatid