Indian Health Service, Whiteriver, AZ, USA.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Rheumatology (Oxford). 2021 Feb 1;60(2):692-698. doi: 10.1093/rheumatology/keaa337.
Statin-associated autoimmune myopathy is a rare condition associated with the formation of autoantibodies to 3-hydroxy-3-methylglutaryl-coenzyme A reductase. Underlying environmental and genetic risk factors remain poorly understood. American Indians have high rates of cardiovascular disease and associated co-morbidities that require lipid-lowering therapies. We observed this autoimmune myopathy in a series of American Indian statin users in rural Arizona.
We reviewed the charts of six American Indian patients with statin-associated autoimmune myopathy. We provide an illustrative case in addition to summaries of clinical presentations and treatment courses.
This is the first report of statin-associated autoimmune myopathy in American Indians. These cases were all identified at the same geographically isolated hospital that exclusively serves an American Indian population with only 1800 statin users. There is relatively low migration. Each case was consistent with the previously described classical presentations for the disease. All six of our cases had diabetes and developed myopathy on high-dose atorvastatin, often with a recent change in statin type or dose.
Providers serving American Indians need to be aware of the possibility of statin-associated autoimmune myopathy and familiar with its presentation. Larger, inclusive, population-based investigations are needed to elucidate risk factors for this condition, in particular the potential interactions between predisposing HLA alleles, diabetes and specific statin exposures. This is necessary to identify effective and safe lipid-lowering medications.
他汀类药物相关自身免疫性肌病是一种罕见的疾病，与 3-羟基-3-甲基戊二酰辅酶 A 还原酶自身抗体的形成有关。潜在的环境和遗传危险因素仍知之甚少。美洲印第安人患有心血管疾病和相关合并症的比率很高，需要进行降脂治疗。我们在亚利桑那州农村的一系列使用他汀类药物的美洲印第安人中观察到了这种自身免疫性肌病。
我们回顾了六位患有他汀类药物相关自身免疫性肌病的美洲印第安患者的病历。我们提供了一个说明性的病例，以及对临床表现和治疗过程的总结。
这是首例在美洲印第安人中发现的他汀类药物相关自身免疫性肌病。这些病例均在同一地理位置偏远的医院中发现，该医院专门为仅有 1800 名他汀类药物使用者的美洲印第安人群提供服务，其移民率相对较低。每种情况都符合该疾病先前描述的典型表现。我们的六个病例均有糖尿病，且在大剂量阿托伐他汀治疗时发生肌病，通常是由于他汀类药物类型或剂量最近发生了变化。
为美洲印第安人提供服务的医务人员需要意识到他汀类药物相关自身免疫性肌病的可能性，并熟悉其表现。需要进行更大规模、包容性、基于人群的调查，以阐明该病症的危险因素，特别是易感 HLA 等位基因、糖尿病和特定他汀类药物暴露之间的潜在相互作用。这对于确定有效和安全的降脂药物是必要的。
