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 / The ACR’s State-of-the-Art Clinical Symposium: Rheumatic, Malignant Disease Mimics Call for Diligence from Rheumatologists

The ACR’s State-of-the-Art Clinical Symposium: Rheumatic, Malignant Disease Mimics Call for Diligence from Rheumatologists

July 14, 2015 • By Thomas R. Collins

  • Tweet
  • Email
Print-Friendly Version / Save PDF

Andrew Mammen, MD, PhD, an investigator with the National Institute of Arthritis and Musculoskeletal and Skin Diseases, stood next to a slide listing 40 medications—all of which can cause myotoxicity.

You Might Also Like
  • The ACR’s State-of-the-Art Clinical Symposium: Rheumatologists Weigh in on Tough-to-Treat Cases, Paget’s Disease, Imaging
  • ACR 2013 State-of-the-Art Clinical Symposium: How to Identify Signs of Myositis and Metabolic Myopathies
  • The ACR’s State-of-the-Art Clinical Symposium: Stem Cell Therapy in Autoimmune Disease Evolution, Insights
Explore This Issue
July 2015
Also By This Author
  • Effectiveness of Novel Therapies for Cutaneous SLE Explored

“This is just a partial list,” Dr. Mammen said. Statins are prominent on the list because they’re so widely prescribed—13 million Americans are treated with them and to great benefit.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

But, Dr. Mammen said, 5–10% of patients develop myalgias, and about 0.5% will develop CK elevations. Symptoms tend to go away after statins are stopped, but it can sometimes take as long as a year.

Certain statins come with greater risk of causing myopathy.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

“Not all statins are created equal,” Dr. Mammen said. Those metabolized through the CYP3A4 pathway in the liver are more myotoxic, and those that aren’t are less so. Part of the reason for this is probably because so many other drugs are also metabolized through this pathway, he said, including HIV protease inhibitors. One study found that those given simvastatin had a 3,000% increase in statin concentration after HIV protease inhibitors were added. However, patients taking either of two other statins actually saw decreased statin concentrations after HIV protease inhibitors were added.1

Genetics can also increase the risk for developing myopathy. A genome-wide association study of 12,000 patients found that a single SNP—one found in organic anion-transporting polypeptide (OATP1B1), which regulates the hepatic uptake of statins—had a strong correlation for statin-induced myopathy, accounting for 60% of the incidence of statin toxicity in the patients.2

Also, Dr. Mammen said, the SNP distinguishes between the C allele and the T allele—and those with the CC genotype are at the highest risk of myopathy development.

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

“It won’t surprise me if we start to look for this genotype before prescribing statins to patients,” he said, because it could mean those patients should get a lower dose.

He also talked about the discovery of autoantibodies to HMG-CoA reductase (HMGCR), the pharmacological target of statins, in necrotizing myopathy patients. The investigation began with a 71-year-old man who had started a statin and developed myopathy symptoms, but the symptoms did not dissipate once the statin was stopped.

Through further studies, researchers found that this type of myopathy is rare, but for patients who have it, treatment is required. A study of 12 patients found that immunosuppressive treatment, mostly prednisone along with other therapies, lowered creatinine kinase levels and increased strength. Anti-HMGCR levels were lowered, but not reduced to normal levels.3

Pages: 1 2 3 4 | Single Page

Filed Under: Conditions, Meeting Reports Tagged With: AC&R, clinical symposium, Diagnosis, Disease, malignant, mimics, patient care, rheumatic, rheumatologist, TreatmentIssue: July 2015

You Might Also Like:
  • The ACR’s State-of-the-Art Clinical Symposium: Rheumatologists Weigh in on Tough-to-Treat Cases, Paget’s Disease, Imaging
  • ACR 2013 State-of-the-Art Clinical Symposium: How to Identify Signs of Myositis and Metabolic Myopathies
  • The ACR’s State-of-the-Art Clinical Symposium: Stem Cell Therapy in Autoimmune Disease Evolution, Insights
  • ACR 2013 State-of-the-Art Clinical Symposium: Diagnosis and Management of Vasculitis

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 »

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

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)