Sharma Alisha, Musurakis Clio, Nabil Nur Un Nisa, Poudel Bidhya, Trongtorsak Angkawipa
Internal Medicine, AMITA Health Saint Francis Hospital, Evanston, USA.
Endocrinology , Diabetes and Metabolism, Chicago Medical School - Rosalind Franklin University, North Chicago, USA.
Cureus. 2022 Jan 25;14(1):e21613. doi: 10.7759/cureus.21613. eCollection 2022 Jan.
The use of statins has been increasing over the past decade for the primary and secondary prevention of cardiovascular disease worldwide. Subsequently, various side effects have also been unfolding. Muscle-related side effects secondary to statins range from myalgia to rhabdomyolysis and need close monitoring for early detection. Statin-induced necrotizing autoimmune myopathy (SINAM) in particular is unique given its pathophysiology, trigger factor, genetic predisposition, and aggressive management strategy. We present two cases of SINAM and discuss the clinical aspects of diagnosis, investigation, and management. Statin-induced necrotizing autoimmune myopathy usually presents with proximal myopathy along with increased creatinine kinase (CK) levels which do not resolve with only statin discontinuation. Diagnosis should be made with biopsy and 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibody detection. The investigation should also be directed to rule out other etiology of proximal myopathy. In most cases, rechallenge with a statin is unsuccessful and immunosuppressive treatment is essential.
在过去十年中，他汀类药物在全球范围内用于心血管疾病的一级和二级预防的使用一直在增加。随后，各种副作用也不断出现。他汀类药物继发的肌肉相关副作用范围从肌痛到横纹肌溶解，需要密切监测以便早期发现。他汀类药物诱导的坏死性自身免疫性肌病（SINAM）因其病理生理学、触发因素、遗传易感性和积极的管理策略而尤为独特。我们报告两例SINAM病例，并讨论诊断、检查和管理的临床方面。他汀类药物诱导的坏死性自身免疫性肌病通常表现为近端肌病，同时肌酸激酶（CK）水平升高，仅停用他汀类药物并不能使其恢复正常。诊断应通过活检和检测3-羟基-3-甲基戊二酰辅酶A还原酶（HMGCR）抗体来进行。检查还应旨在排除近端肌病的其他病因。在大多数情况下，再次使用他汀类药物进行激发试验是不成功的，免疫抑制治疗至关重要。
