Hinschberger O, Lohmann C, Lannes B, Martzolff L, Vo B D, Jaeger-Bizet F, Ciobanu E, Kieffer P
Service de médecine interne-soins continus, centre hospitalier Emile-Muller, 20, rue du Dr-René-Laennec, 68070 Mulhouse, France.
Laboratoire de microbiologie, centre hospitalier Emile-Muller, 20, rue du Dr-René-Laennec, 68070 Mulhouse, France.
Rev Med Interne. 2014 Aug;35(8):546-9. doi: 10.1016/j.revmed.2013.06.009. Epub 2013 Jul 30.
Statins or 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors (HMGCR) are among the most commonly prescribed treatment in France. They may be responsible for muscular intolerance with variable severity. They have been recently involved in the occurrence of an acquired inflammatory myopathy associated with anti-HMGCR antibodies. This new type of toxic myopathy remains poorly known by clinicians.
We report a 61-year-old woman treated with a statin for many years who developed a lower and upper limb disabling myopathy with a rapid unfavourable course despite treatment withdrawal. Clinical history and investigations, especially including an assay for anti-HMGCR antibodies led to the diagnosis of autoimmune necrotizing myopathy with anti-HMGCR antibodies. Subsequent initiation of an immunosuppressive treatment by corticosteroids and methotrexate was effective.
Statins may unmask or cause an autoimmune necrotizing myopathy associated with the presence of anti-HMGCR antibodies. Their identification is now routinely available. An immunosuppressive treatment is necessary and justified by the autoimmune nature of the disease.
他汀类药物或3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂（HMGCR）是法国最常用的处方药之一。它们可能导致不同严重程度的肌肉不耐受。最近，它们与抗HMGCR抗体相关的获得性炎性肌病的发生有关。这种新型中毒性肌病在临床医生中仍鲜为人知。
我们报告一名61岁女性，多年来一直服用他汀类药物，尽管停药，但仍发展为上下肢致残性肌病，病情迅速恶化。临床病史和检查，特别是包括抗HMGCR抗体检测，导致诊断为抗HMGCR抗体阳性的自身免疫性坏死性肌病。随后开始使用皮质类固醇和甲氨蝶呤进行免疫抑制治疗，效果良好。
他汀类药物可能会揭示或引发与抗HMGCR抗体相关的自身免疫性坏死性肌病。现在常规可进行其鉴定。由于该疾病的自身免疫性质，免疫抑制治疗是必要且合理的。
