The Rheumatologist
COVID-19 NewsACR Convergence
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Gout Resource Center
      • Axial Spondyloarthritis Resource Center
      • Psoriatic Arthritis
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Myositis AutoantibodiesTriggered by Statins

Myositis AutoantibodiesTriggered by Statins

July 14, 2017 • By Lara C. Pullen, PhD

  • Tweet
  • Email
Print-Friendly Version / Save PDF
Close-up of the thigh of a 67-year-old female patient with focal myositis of unknown cause.

Close-up of the thigh of a 67-year-old female patient with focal myositis of unknown cause.
Bacho/shutterstock.com

CHICAGO—On a Saturday morning in Chicago, Chester V. Oddis, MD, director of the Myositis Center at the University of Pittsburgh, explained to a crowded room of about 500 rheumatologists attending the ACR’s State-of-the-Art Clinical Symposium in April how best to use myositis autoantibodies in clinical care.

You Might Also Like
  • Statins Linked to Idiopathic Inflammatory Myositis
  • Managing Myositis in 3 Different Scenarios
  • ACR 2013 State-of-the-Art Clinical Symposium: How to Identify Signs of Myositis and Metabolic Myopathies
Explore This Issue
July 2017
Also By This Author
  • Lateral Hip Pain: Could It Be Gluteal Tendinopathy?

He began with an overview of the different types of myositis and explained that patients with myositis are symmetrically weak and meet several diagnostic criteria. Specifically, they may have elevated serum enzymes, such as creatine kinase (CK), aldolase, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH). They also have myopathic electromyographic abnormalities, such as sharp waves, fibrillations and polyphasic motor units. Finally, they have muscle pathology that is characterized by myofiber degeneration/regeneration, mononuclear cell infiltrates and perifascicular atrophy.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Many patients with myositis also have rashes and are thus diagnosed with dermatomyositis (DM), which is a much easier diagnosis to make than polymyositis (PM), which represents a diagnostic challenge. This is because there are many mimics of PM and therefore a muscle biopsy is necessary for its diagnosis. In particular, PM has histologic features that distinguish it from dermatomyositis. Histology reveals that “from a histopathological perspective, PM and DM are almost like different diseases in their own rights,” noted Dr. Oddis. “If you look at the histology, even from a distance, they look different,” he explained, pointing to the two histological examples projected onto the large screens.

Statins & Myopathy

Dr. Oddis transitioned from this overview to an example of a newer autoantibody marker for myositis. In this case, the autoantibody is triggered by the use of statins, which are increasingly prescribed around the world. Rheumatologists have noted that “lots of patients on statins get muscle symptoms,” explained Dr. Oddis. Some of these patients get referred to rheumatology.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

When Dr. Oddis sees a patient with statin-induced muscle symptoms and/or increased levels of creatine kinase (CK), he discontinues the statin. In many cases, the symptoms normalize, and Dr. Oddis does not perform a workup. Instead, he recommends that the referring physician prescribe a different statin or cholesterol-lowering agent to the patient. In some cases, however, he found that the symptoms persisted and/or the CK remained elevated even after the statin was discontinued. “I was seeing patients where I thought, ‘Geez, there is something else going on,’” noted Dr. Oddis.

He described one of these patients in detail to the audience. She was a 67-year-old Caucasian woman with hypertension, hyperlipidemia and uterine cancer. In 2004, she was prescribed atorvastatin, and in 2008, she experienced lower extremity weakness. By 2009, she had difficulty walking up steps and lifting her arms over her head. She stopped the atorvastatin on her own, but saw no improvements in weakness. Blood tests revealed CKs of 6473 and then 9375, and she was admitted to the hospital, where a muscle biopsy revealed myonecrosis with many necrotic fibers. There was, however, no inflammation or vasculitis. Dr. Oddis treated her with prednisone and saw improvements in her CK level and muscle weakness. Unfortunately, when he tapered the prednisone, the CK levels went back up. There were no other autoimmune manifestations and no family history of autoimmune disease. She also did not have the rashes that are characteristic of DM. He diagnosed her with statin myopathy, but the patient was reluctant to increase her prednisone dose.

‘From a histopathological perspective, PM & DM are almost like different diseases in their own rights. If you look at the histology, even from a distance, they look different,’ Dr. Oddis explained, pointing to the two histological examples projected onto the large screens.

Around this time, there were descriptions in the medical literature of immune-mediated necrotizing myopathy associated with statins. These patients presented with proximal weakness during or after statin use. The patients had elevated CK, and their persistent weakness and elevated CK continued despite stopping the statin. The patients did improve, however, with immunosuppressive agents. This improvement occurred despite the fact that muscle biopsies revealed necrotizing myopathy in the absence of significant inflammation. These observations led many rheumatologists to question whether these patients actually had PM.

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

Pages: 1 2 | Single Page

Filed Under: Conditions, Meeting Reports, Soft Tissue Pain Tagged With: 2017 State of the Art Clinical Symposium, AC&R, American College of Rheumatology, dermatomyositis, Diagnosis, muscle, myositis, Pain, patient care, polymyositis, Research, rheumatologist, rheumatology, Statin, Treatment, weaknessIssue: July 2017

You Might Also Like:
  • Statins Linked to Idiopathic Inflammatory Myositis
  • Managing Myositis in 3 Different Scenarios
  • ACR 2013 State-of-the-Art Clinical Symposium: How to Identify Signs of Myositis and Metabolic Myopathies
  • Tips for Myositis Management

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

ACR Convergence

Don’t miss rheumatology’s premier scientific meeting for anyone involved in research or the delivery of rheumatologic care or services.

Visit the ACR Convergence site »

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts site »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use / Cookie Preferences

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2023 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)