Both myalgia and myopathy are well-known potential side effects of statins. However, a rare and severe form of statin-induced necrotizing autoimmune myopathy (SINAM) has recently been described and can lead to debilitating weakness, often requiring immunosuppressive therapy.

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 …

Among autoimmune manifestations associated with statins, there is immune-mediated necrotizing myopathy (IMNM). ABSTRACT. Statins are widely prescribed medications to prevent cardiovascular events. While self-limited statin myopathy is relatively common, statin-induced necrotizing autoimmune myopathy (SINAM) is extremely uncommon, with incidence of two cases per million per year.

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Statin-induced necrotizing autoimmune myopathy (SINAM) is a rare side effect of statin use which manifests as progressive muscle weakness. Because statins are a widely prescribed medication for coronary artery disease, hyperlipidemia, and many other diseases, many patients are at risk of developing SINAM or one of the many other statin-induced myopathies. Importance Necrotizing autoimmune myopathy (NAM) is characterized pathologically by necrotic muscle fibers with absent or minimal inflammation. It is often accompanied by statin therapy, connective tissue diseases, cancer, and autoantibodies specific for signal recognition particle (SRP) or 3-hydroxy-3-methylglutaryl–coenzyme A reductase (HMGCR).

This suggests that statins can cause or unmask an immune mediated myopathy.

The development of necrotizing myopathy after statin exposure is insufficient to make the diagnosis. Testing must first exclude other causes of myositis and necrotizing myopathy. [6] A muscle biopsy consistent with SAAM will demonstrate muscle cell death with muscle fiber regeneration and typically has few inflammatory cells.

Statins are widely used and lower the risk of death from cardiovascular causes. In a fraction of patients, an autoimmune myopathy may develop, characterized by the development of autoantibodies to Immunosuppressive therapy with steroids or other drugs are effective in reversing the disease in most patients, Mammen says. In his initial research, Mammen and his colleagues focused on 26 patients at the Johns Hopkins Myositis Center with necrotizing myopathy, a muscle-wasting disorder with no known cause.

16 Oct 2018 Compared with statin-associated anti-HMGCR Ab–positive IMNM, A majority of patients with immune-mediated necrotizing myopathy 

Diagnosis is confirmed by positive anti-HMG-CoA reductase autoantibody. 2. Recent evidence now suggests that immune-mediated necrotizing myopathy is not one disease, but can be divided on the basis of the presence of distinct autoantibodies recognizing either the signal recognition particle or 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase. tinuation of statin.

The association of statins with necrotizing myopathy is strengthened by the discovery that the serum of some of these patients contains an anti-HMGCR antibody. Statin-Induced Necrotizing Autoimmune Myopathy Maristela B. Garcia, M.D., and Erin Atkinson Cook, M.D. Clinical Vignette A 76-year-old man with a history of two prior strokes complicated by residual mild cognitive impairment, atrial fibrillation, coronary artery disease, diabetes mellitus type 2, The development of necrotizing myopathy after statin exposure is insufficient to make the diagnosis. Testing must first exclude other causes of myositis and necrotizing myopathy. A muscle biopsy consistent with SAAM will demonstrate muscle cell death with muscle fiber regeneration and typically has few inflammatory cells. Statin-associated necrotizing myopathy is a symmetric proximal muscle weakness associated with extreme elevations of CK. It is common in males and can occur after months of statin use. It is associated with necrosis on muscle biopsy and the presence of anti-HMG-CoA reductase antibodies. For some patients, statins cause necrotizing myopathy, a form of the rare idiopathic inflammatory myopathy, also known as myositis.
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Mauro Turrin 1. 1 Former Department of Internal Medicine, Ospedali Riuniti Padova Sud, Monselice (Padova), Italy.

tinuation of statin. More recently, an immune-mediated necrotizing myopathy has been found to be associated with statin use which in most cases requires treatment with immunosuppressants.
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Patients who have anti-HMGCR antibodies and use statin medications to control high cholesterol may unknowingly develop this type of statin-induced necrotizing  

The review aims to define this heterogeneous entity and summarize the salient clinical, laboratory, and muscle biopsy findings, in order to facilitate the diagnosis and treatment of this condition. Recent findings Statin Statin-associated IMNM is a recently described entity based on the development of autoantibodies against the enzyme HMGCR, and leads to a necrotizing myopathy requiring immunosuppressive therapy. 7 In this review, we recapitulate the definition, clinical picture, pathophysiology and therapeutic options of the anti-HMGCR myopathy. Statin Myopathy 2020-12-29 · We report a rare case of statin-associated anti-HMGCR immune-mediated necrotizing myopathy with dermatomyositis-like cutaneous features. The possibility of anti-HMGCR immune-mediated necrotizing myopathy should be considered in patients with cutaneous dermatomyositis-like features associated with severe proximal muscle weakness, highly elevated creatine kinase levels and possible statin exposure.