Statin-associated immune-mediated necrotizing myositis in Native Americans

Muruganandam, Maheswari; Iqbal, Ahsan; Akpan, Eyerusalem B; Dolomisiewicz, Anthony C; Waters, Yvonne M; Emil, N. Suzanne; Nunez, Sharon E; McElwee, Matthew K.; O’Sullivan, Frank X.; Fields, Roderick A.; Sibbitt, Wilmer L.

doi:10.1093/rheumatology/keac198

Cited by 7 publications

(4 citation statements)

References 42 publications

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“…Immune-mediated necrotizing myopathy (IMNM) is an increasingly recognized muscle disease often linked to statin use and occurs in about two to three patients for every 100,000 individuals exposed to statins [ 1 ]. However, in certain populations, statin-induced IMNM is now the most commonly observed form (> 50% of all cases) of inflammatory muscle disease [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Statin-Induced Immune-Mediated Necrotizing Myopathy Resulting in Proximal Muscle Weakness

Abdalla

Abdel-Jalil

2023

J Med Cases

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Statin-induced immune-mediated necrotizing myopathy (IMNM) is a subtype of IMNM linked to exposure to statins and is characterized by positive anti-hydroxymethylglutaryl (HMG) coenzyme A reductase (HMGCR) antibodies. Although rare, this entity has become increasingly recognized as a cause of proximal muscle weakness, especially with the widespread use of statin therapy. Unlike typical statin-associated muscle symptoms, IMNM myopathy often causes severe muscle injury, and muscle weakness persists or sometimes worsens following the withdrawal of statin therapy. Medical practitioners need to keep a high index of clinical suspicion for statininduced IMNM in patients taking statins who present with muscle weakness. The disease can be debilitating, and treatment strategies are not well established despite the advances that have been made in the diagnosis. Here we present the clinical characteristics and disease course of two cases of statin-induced IMNM. Both patients presented with progressive proximal muscle weakness and myalgias while on long-term statin therapy without significant improvement in their symptoms following the withdrawal of statin therapy. IMNM was suspected, and both patients were found to have high titers of anti-HMG coenzyme A reductase antibodies and demonstrated microscopic features consistent with a diagnosis of IMNM on muscle biopsy. The patients experienced significant disability due to muscle weakness and required a protracted course of escalated immunosuppressive therapy. Although rare, IMNM should be suspected in patients taking statins who present with muscle weakness that fails to improve or worsens when statins were stopped. Early diagnosis and institution of immunosuppressive therapy are important to prevent the progression of the disease.

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Section: Introductionmentioning

confidence: 99%

Statin-Induced Immune-Mediated Necrotizing Myopathy Resulting in Proximal Muscle Weakness

Abdalla

Abdel-Jalil

2023

J Med Cases

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“…Immune-mediated necrotizing myopathy (IMNM) is an increasingly common and serious condition in which autoantibodies attack muscle fbers causing clinically signifcant muscle weakness, fatigue, and myalgia [1][2][3]. IMNM can be classifed into three subtypes: antisignal recognition particles, anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR), and seronegative [4].…”

Section: Introductionmentioning

confidence: 99%

Immune-Mediated Necrotizing Myopathy Manifesting after Five Years of Statin Therapy

DeRon

Fischer

Lopez

et al. 2023

Case Reports in Rheumatology

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Immune-mediated necrotizing myopathy (IMNM) is an increasingly common and serious condition in which autoantibodies attack muscle fibers causing clinically significant muscle weakness, fatigue, and myalgias. Recognizing the clinical presentation of IMNM is difficult but necessary, as rapid intervention decreases morbidity. We present a case of a 53-year-old female with IMNM induced by statin therapy with confirmed anti-3-hydroxy-3-methylglutaryl coenzyme A reductase antibodies present on serologic testing. The patient’s statin therapy was halted, and the patient was provided with one dose of methylprednisolone and ongoing therapy with mycophenolate. She showed subsequent slow improvements in her muscle weakness and myalgias. It is important for clinicians to be aware of the possible consequences of statin therapy, as these drugs are generally regarded as benign in the medical community. Clinicians should also be aware that statin-induced myopathy can occur at any time during statin therapy. The condition does not necessarily correlate with beginning a new statin medication, as demonstrated in this case in which the patient was on chronic statin therapy before developing symptoms. Continued clinician education and building the fund of medical knowledge regarding this disease are vital to enable clinicians to recognize this disease and act promptly to reduce patient morbidity and improve outcomes.

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“…11 Although biopsy is commonly used to diagnose and classify muscle disease and can be performed also in tendons and ligaments, the spontaneous rupture rates of abnormal tendons and ligaments are quite high, thus, biopsy of tendons and ligaments with subsequent spontaneous rupture has intrinsic legal and interpretive implications. 12,13 Further, the pathology in muscle and tendon disease is often focal or multifocal, thus, noninvasive imaging techniques including sonoelastography are extremely important for studying muscles, tendons, nerves, and ligaments to obviate the need for biopsy or to direct the biopsy to an area of proven abnormality for a definitive diagnosis. 12,13 In this issue of Journal of Clinical Ultrasound, Hong and colleagues report the results of strain elastography and shear wave elastography in the evaluation of lateral epicondylitis and associated imaging pathology in the common extensor tendon.…”

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confidence: 99%

“…12,13 Further, the pathology in muscle and tendon disease is often focal or multifocal, thus, noninvasive imaging techniques including sonoelastography are extremely important for studying muscles, tendons, nerves, and ligaments to obviate the need for biopsy or to direct the biopsy to an area of proven abnormality for a definitive diagnosis. 12,13 In this issue of Journal of Clinical Ultrasound, Hong and colleagues report the results of strain elastography and shear wave elastography in the evaluation of lateral epicondylitis and associated imaging pathology in the common extensor tendon. 5 This report demonstrated sonoelastographic abnormalities in the common extensor tendon by both shear wave and strain elastography that were more pronounced than gray scale B-mode US imaging.…”

mentioning

confidence: 99%