Webster Patrick, Wiemer Nicholas, Al Harash Abdalhamid, Marshall Cody, Khatoon Nazia, Lucke Michael
Department of Internal Medicine, Allegheny Health Network, Pittsburgh, USA.
Department of Rheumatology, Allegheny Health Network, Pittsburgh, USA.
Case Rep Rheumatol. 2021 Feb 24;2021:8810754. doi: 10.1155/2021/8810754. eCollection 2021.
Myalgia and mild elevation in muscle enzymes are common side effects of statin therapy. While these symptoms are generally self-limited, in rare cases, statin use is associated with an immune-mediated necrotizing myopathy caused by development of autoantibodies against HMG-CoA reductase. The primary presenting symptom of this condition is progressive symmetric proximal weakness that does not abate or worsens even after cessation of statin therapy and is associated with markedly elevated creatine kinase (CK) levels. To date, no randomized controlled trials have been conducted to identify the most effective treatment for statin-associated autoimmune myopathy. Treatment recommendations involve a combination of steroids and immunosuppressive drugs. This single-center case series highlights the clinicopathologic features diagnostic for statin-associated autoimmune myopathy as well as treatment challenges for the patient population. The series highlights a range of potential presentations, from mildly symptomatic despite highly elevated CK, to severe muscle weakness including dysphagia. Multiple patients required several immunosuppressant medications as well as intravenous immunoglobulin (IVIG) to achieve disease control. In this case series, marked improvement was noted in several diabetic patients with IVIG.
肌痛和肌肉酶轻度升高是他汀类药物治疗的常见副作用。虽然这些症状通常是自限性的，但在罕见情况下，他汀类药物的使用与一种免疫介导的坏死性肌病有关，这种肌病是由针对HMG-CoA还原酶的自身抗体产生所致。这种疾病的主要表现症状是进行性对称性近端肌无力，即使在停用他汀类药物治疗后也不会减轻或反而加重，且与肌酸激酶（CK）水平显著升高有关。迄今为止，尚未进行随机对照试验来确定治疗他汀类药物相关自身免疫性肌病的最有效方法。治疗建议包括使用类固醇和免疫抑制药物。这个单中心病例系列突出了他汀类药物相关自身免疫性肌病的临床病理特征以及该患者群体的治疗挑战。该系列突出了一系列潜在表现，从CK水平高度升高但症状轻微，到严重的肌无力包括吞咽困难。多名患者需要多种免疫抑制药物以及静脉注射免疫球蛋白（IVIG）来控制病情。在这个病例系列中，数名糖尿病患者接受IVIG治疗后有明显改善。
