Statiny indukovaná nekrotizující autoimunitní myopatie

HORÁK, Tomáš, Stanislav VOHÁŇKA, Eliška TVRDÍKOVÁ, Magda HORÁKOVÁ and Josef BEDNAŘÍK. Statiny indukovaná nekrotizující autoimunitní myopatie (Statin-induced Necrotizing Autoimmune Myopathy). Ceska a slovenska neurologie a neurochirurgie. Praha: Nakladatelské a tiskové středisko ČLS JEP, 2017, vol. 80, No 5, p. 569-577. ISSN 1210-7859. Available from: https://dx.doi.org/10.14735/amcsnn2017569.

Basic information

• Original name: Statiny indukovaná nekrotizující autoimunitní myopatie
• Name (in English): Statin-induced Necrotizing Autoimmune Myopathy
• Authors: HORÁK, Tomáš (203 Czech Republic, guarantor, belonging to the institution), Stanislav VOHÁŇKA (203 Czech Republic, belonging to the institution), Eliška TVRDÍKOVÁ (203 Czech Republic, belonging to the institution), Magda HORÁKOVÁ (203 Czech Republic, belonging to the institution) and Josef BEDNAŘÍK (203 Czech Republic, belonging to the institution).
• Edition: Ceska a slovenska neurologie a neurochirurgie, Praha, Nakladatelské a tiskové středisko ČLS JEP, 2017, 1210-7859.

Other information

• Original language: Czech
• Type of outcome: Article in a journal
• Field of Study: 30103 Neurosciences
• Country of publisher: Czech Republic
• Confidentiality degree: is not subject to a state or trade secret
• Impact factor: Impact factor: 0.508
• RIV identification code: RIV/00216224:14110/17:00098483
• Organization unit: Faculty of Medicine
• Doi: http://dx.doi.org/10.14735/amcsnn2017569
• UT WoS: 000412370300009
• Keywords in English: myopathy; statins; autoimmunity; necrosis; autoantibodies; anti-HMGCR
• Tags: EL OK
• Tags: International impact, Reviewed

Abstract

Léčba statiny může být ve vzácných případech asociována s tvorbou specifických autoprotilátek proti 3-hydroxy-3-metylglutaryl koenzym A reduktáze (anti-HMGCR), pletencovou svalovou slabostí, zvýšenou hladinou kreatinkinázy (CK) a nekrózou myofibril ve svalové biopsii. Přítomnost těchto znaků tvoří hlavní kritéria nově definované nozologické jednotky označované jako statiny indukovaná nekrotizující myopatie (Statin Induced Necrotizing Autoimmune Myopathy; SINAM). Předpokládaná autoimunitní etiopatogeneze opodstatňuje použití kombinované imunosupresivní terapie. Klinický průběh, diagnostická kritéria i terapeutická účinnost imunosupresivní léčby jsou u SINAM obdobné jako u imunitně zprostředkované nekrotizující myopatie (Immune Mediated Necrotizing Myopathy; IMNM) bez asociace s léčbou statiny.

Abstract (in English)

Aim: Statin therapy might be rarely associated with production of specific autoantibodies against 3-hydroxy-3-methylglutaryl coenzyme A reductase (anti-HMGCR), proximal muscle weakness, high creatine kinase (CK) levels and myofibril necrosis in muscle biopsy. Presence of these symptoms established the main criteria of a new clinical unit called Statin Induced Necrotizing Autoimmune Myopathy (SINAM). Assumed autoimmune etiopathogenesis justifies the use of combined immunosuppressive therapy. Clinical course, diagnostic criteria and therapeutic efficacy of immunosuppressive treatment are similar to that of Immune Mediated Necrotizing Myopathy (IMNM) without association with statin therapy. Methods: The group of 7 SINAM patients was classified by reassessment of the diagnostic group of 30 patients diagnosed with autoimmune myopathies based on determination of anti-HMGCR antibodies, structured quantitative revision of muscle biopsies and detailed medical history (confirming chronic statin therapy). Results: In total 30 subjects with the original diagnosis dermatomyositis, polymyositis or IMNM were tested for HMGCR antibodies. Twelve patients out of them were anti-HMGCR positive (IMNM 5x, 7x PM) and 7 of them had been on statin therapy before the symptoms developed. These 7 patients were reclassified as SINAM. Myofibrillar necrosis was found in their muscle biopsies in all cases and 5 patients also had inflammatory cell infiltration. All these patients had significantly elevated CK levels (> 10 fold) at early stage of the disease. Combined immunosuppression led to remission of clinical symptoms and normalization or significant CK level drop in all patients.

Links

• MUNI/A/1072/2015, interní kód MU: Name: Diagnostika a patofyziologie neuropatické bolesti (Acronym: PNB)

Investor: Masaryk University, Category A