Anti-HMGCR immune-mediated necrotising myopathy: Addressing the remaining issues

Khoo, Thomas; Chinoy, Hector

doi:10.1016/j.autrev.2023.103468

Cited by 18 publications

(5 citation statements)

References 97 publications

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“…Die Pathogenität der Antikörper konnte ebenfalls in Tiermodellen bestätigt werden [69]. Wichtig ist zu unterscheiden, dass es sich bei der IMNM im Gegensatz zur allgemeinen Statin-Myotoxizität um eine eigene Erkrankungsentität handelt, da sich die Symptome aufgrund der autoimmunen Genese auch nach Beendigung der Statintherapie fortsetzen sowie teilweise erst Monate bis Jahre nach Statinbeginn beginnen können [70] (s. ▶Tab. 3).…”

Section: Immunvermittelte Nekrotisierende Myositisunclassified

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Dermatomyositis, Antisynthetase-Syndrom und immunvermittelte nekrotisierende Myopathie

Holzer,

Krusche,

Kötter

2024

Aktuelle Rheumatologie

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ZusammenfassungDie inflammatorischen Myopathien werden heutzutage anhand von Klinik, Biopsie und Antikörperstatus genauer gegliedert. Zumeist sind sowohl die Dermatomyositis, das Antisynthetase-Syndrom (ASyS) und die Immunvermittelte nekrotisierende Myopathie (IMNM) durch proximale Muskelschwäche gekennzeichnet, wobei jedoch einige Entitäten auch amyopathisch verlaufen können. Je nach vorliegender Antikörperart kann die Dermatomyositis jeweils unterschiedliche Manifestationen aufweisen, wobei die interstitielle Lungenerkrankung (ILD) als häufigste extramuskuläre Beteiligung zu erwähnen ist. Ein besonderes Augenmerk sollte auf das Tumorscreening bei Vorliegen entsprechender Risikofaktoren, wie beispielsweise bei anti-TIF1γ oder anti-NXP2-positivem Antikörperstatus bei Erwachsenen, gelegt werden. Die IMNMs sind bekanntermaßen mit einer Statinexposition assoziiert, allerdings sollte bedacht werden, dass eine Statinexposition nicht zwingend nötig ist, um eine IMNM zu entwickeln. Das ASyS präsentiert sich regulär mit einer Triade aus Myositis, Arthritis und ILD, welche jedoch nicht immer vorliegen muss. Therapeutisch unterscheiden sich die drei Gruppen initial nicht. Eine überbrückende Prednisolontherapie (je nach Schweregrad oral oder intravenös) wird initiiert und je nach Grunderkrankung und Organbeteiligung parallel eine steroidsparende Erhaltungstherapie etabliert. Eine ergänzende Physiotherapie sowie bei Bedarf auch Ergo- oder Logopädie sind wichtige Bausteine der Therapie und sollten frühzeitig begonnen werden.

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Section: Immunvermittelte Nekrotisierende Myositisunclassified

“…, -Jo1, -ASyS-Antikörper-PositivitätAusgeprägte DysphagieAnti-SAE, -HMGCR, -Mi2, -MDA5-Positivität Anti-PM-Scl, -Ku, -RNP, -SSA/SSB-Unterscheidung zwischen Statin-Myotoxizität und anti-HMGCR-positiver IMNM[70].…”

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Dermatomyositis, Antisynthetase-Syndrom und immunvermittelte nekrotisierende Myopathie

Holzer,

Krusche,

Kötter

2024

Aktuelle Rheumatologie

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“…[1][2][3] Anti-HMGCR IMNM can occur with or without a history of statin exposure, and patients who have been exposed to statins tend to be older and more responsive to immunotherapy than those who are statin-naive and young. 2,4,5 However, regardless of age or statin exposure, the current consensus recommends aggressive immunotherapy including high-dose oral steroids for the initial treatment. 2 Here, we present a case of an 81-year-old woman after statin exposure who was successfully treated with a reduced oral steroid dosage.…”

Section: Dear Editormentioning

confidence: 99%

“…1,2 Importantly, renal function plays a crucial role in drug metabolism and elimination, making the kidney susceptible to the effects of polypharmacy, including decreasing renal function in older people. 3,4 In the present study, to elucidate the relationship between renal function and medication use, we counted the number of drugs that older patients took and analyzed the correlation between this number and indexes of renal function, including levels of serum creatinine, blood urea nitrogen (BUN), and estimated glomerular filtration rate (eGRF). This was a single-center retrospective observational study using the data of 312 outpatients (male: 123, female: 209) older than 64 years of age who visited the Tohoku Medical and Pharmaceutical University Hospital.…”

Section: Number Of Medicines Taken Correlates With Renal Function In ...mentioning

confidence: 99%

Successful treatment with reduced oral steroid dosage in an 81‐year‐old woman with statin‐induced anti‐HMGCR immune‐mediated necrotizing myopathy

Kondo,

Kurihara,

Higashihara

et al. 2024

Geriatrics Gerontology Int

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“…Clinically, they have an acute to subacute presentation with marked proximal weakness and dysphagia. Generally, extra-muscular manifestation is absent [ 2 ]. An observational study by Allenbach et al demonstrated that malignancy occurred more frequently (17.3%) in HMGCR-positive patients compared to the general population.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Management of Paraneoplastic Necrotizing Myopathy in Thyroidectomy: A Case Report

Wong

2024

Cureus

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Perioperative management of patients with myopathies can be challenging due to the increased risk of malignant hyperthermia (MH) and anesthesia-induced rhabdomyolysis (AIR). However, currently, there is no evidence regarding the optimal anesthetic management for paraneoplastic necrotizing myopathy (PNM) (total intravenous anesthetic vs. volatile anesthetics). Here, I report a case where anesthesia was administered safely using volatile anesthetics. A 63-year-old female presented with PNM associated with papillary thyroid carcinoma, necessitating urgent thyroidectomy. The patient, previously diagnosed with anti-3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR) antibody-associated myopathy, exhibited progressive weakness and dysphagia, prompting suspicion of PNM. The patient's compromised respiratory status, attributed to tracheal compression by a large goiter, necessitated an urgent thyroidectomy. Anesthetic management considerations included the potential effect of HMGCR-M on respiratory muscles and the need for careful planning to mitigate postoperative complications. The patient underwent total thyroidectomy, left central compartment clearance, and tracheostomy. The surgery proceeded uneventfully, with meticulous monitoring and adjustment of anesthetic agents to maintain hemodynamic stability. Postoperatively, the patient recovered well, demonstrating complete resolution of neurological symptoms during a three-month follow-up. The case underscores the importance of recognizing paraneoplastic syndromes in the context of thyroid surgery and highlights potential challenges faced by anesthesiologists. Despite the lack of established safety data for anesthetic drugs in HMGCR-M necrotizing myopathy, the case demonstrates the successful use of sevoflurane and rocuronium.

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Anti-HMGCR immune-mediated necrotising myopathy: Addressing the remaining issues

Cited by 18 publications

References 97 publications

Dermatomyositis, Antisynthetase-Syndrom und immunvermittelte nekrotisierende Myopathie

Dermatomyositis, Antisynthetase-Syndrom und immunvermittelte nekrotisierende Myopathie

Successful treatment with reduced oral steroid dosage in an 81‐year‐old woman with statin‐induced anti‐HMGCR immune‐mediated necrotizing myopathy

Perioperative Management of Paraneoplastic Necrotizing Myopathy in Thyroidectomy: A Case Report

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