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Meznaric M, Fumic K, Leonardis L. Selective screening of late-onset Pompe disease (LOPD) in patients with non-diagnostic muscle biopsies. J Clin Pathol 2019; 72:468-472. [PMID: 30878973 DOI: 10.1136/jclinpath-2018-205446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 02/03/2019] [Accepted: 02/22/2019] [Indexed: 11/04/2022]
Abstract
AIMS As of 2016, there were five patients with Pompe in Slovenia (two infantile, one childhood and two adult onset) with a prevalence of 1:400 000; however, the prevalence of late-onset Pompe disease (LOPD) in some other countries means this ratio could be an underestimate. Since an LOPD muscle biopsy could be unspecific or even normal, the purpose of this study is to assess the prevalence of LOPD in patients with non-diagnostic muscle biopsies. METHODS Six hundred biopsies were recorded at the Neuromuscular Tissue Bank of the University of Ljubljana for the period 2004-2014. All adult patients with non-diagnostic muscle biopsies were invited to the National Slovenian Neuromuscular Centre for dried blood spot testing for LOPD. RESULTS A total of 90 patients (56% of those invited) responded. No patient with LOPD was found. A total of 49 patients (54%) had fixed muscle weakness, 31 (34%) had mild symptoms and no weakness and 10 (11%) had asymptomatic hyperCKemia. Ventilatory insufficiency associated with proximal muscle weakness was found in two patients (2%). No patients exhibited vacuolar myopathy, globular accumulations of glycogen or regions of increased acid phosphatase activity within the sarcoplasm. CONCLUSIONS The study results do not support the hypothesis that LOPD is underestimated in Slovenian patients with non-diagnostic muscle biopsies; this could be consistent with the fact that LOPD is of low prevalence in Slovenia, as is the case in the populations of Finland, French-speaking Belgium, west Sweden and west Denmark.
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Affiliation(s)
- Marija Meznaric
- Faculty of Medicine, Institute of Anatomy, University of Ljubljana, Ljubljana, Slovenia
| | - Ksenija Fumic
- Department of Laboratory Diagnostics, Division for Laboratory Diagnostics of Inborn Errors of Metabolism, University Hospital Center Zagreb, Zagreb, Croatia.,Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Lea Leonardis
- Division of Neurology, Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Diamond DM, de Lorgeril M, Kendrick M, Ravnskov U, Rosch PJ. Formal comment on "Systematic review of the predictors of statin adherence for the primary prevention of cardiovascular disease". PLoS One 2019; 14:e0205138. [PMID: 30653537 PMCID: PMC6336291 DOI: 10.1371/journal.pone.0205138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/08/2018] [Indexed: 12/19/2022] Open
Abstract
Statins have been prescribed for primary prevention of cardiovascular disease (CVD) for nearly 3 decades. Throughout this period key opinion leaders in the field have been dismayed by the high rate of non-adherence of patients to follow their statin regimen. Hope et al., [1] have addressed this issue by providing a systematic review of research on predictors of statin adherence for primary prevention of CVD. However, their review does not address the ongoing debate as to whether statin treatment is warranted for primary prevention of CVD, nor does it adequately address concerns regarding adverse effects of statins. We have therefore written a commentary which provides a broader perspective on the benefits versus harms of statin therapy. Our perspective of the literature is that non-adherence to statin treatment for primary prevention of CVD is justified because the meager benefits are more than offset by the extensive harms.
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Affiliation(s)
- David M. Diamond
- Departments of Psychology, University of South Florida, Tampa, FL, United States of America
- Molecular Pharmacology & Physiology, University of South Florida, Tampa, FL, United States of America
- * E-mail:
| | - Michel de Lorgeril
- Laboratoire Coeur et Nutrition, TIMC-IMAG, School of Medicine, University of Grenoble-Alpes, Grenoble, France
| | - Malcolm Kendrick
- East Cheshire Trust, Macclesfield District General Hospital, Macclesfield, Cheshire, United Kingdom
| | | | - Paul J. Rosch
- New York Medical College; Valhalla, New York
- The American Institute of Stress, Fort Worth, TX
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Statin-associated immune-mediated necrotizing myopathy: a retrospective analysis of individual case safety reports from VigiBase. Eur J Clin Pharmacol 2018; 75:409-416. [DOI: 10.1007/s00228-018-2589-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/29/2018] [Indexed: 12/20/2022]
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Caughey GE, Gabb GM, Ronson S, Ward M, Beukelman T, Hill CL, Limaye V. Association of Statin Exposure With Histologically Confirmed Idiopathic Inflammatory Myositis in an Australian Population. JAMA Intern Med 2018; 178:1224-1229. [PMID: 30073275 PMCID: PMC6142971 DOI: 10.1001/jamainternmed.2018.2859] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Statin medications are widely prescribed for cardiovascular risk reduction. Myalgia and rhabdomyolysis are well-recognized adverse effects of statins, and they resolve with the cessation of statin therapy. Idiopathic inflammatory myositis (IIM) is a heterogeneous group of autoimmune myopathies that may also be associated with statin use. Recently, statin-associated autoimmune myopathy has been recognized as a distinct entity with the presence of specific autoantibodies against hydroxymethylglutaryl-coenzyme A reductase, which results in a necrotizing myositis that does not resolve with cessation of statin therapy and requires treatment with immunosuppressive agents. OBJECTIVE To examine the association between histologically confirmed IIM and current exposure to statin medications. DESIGN, SETTING, AND PARTICIPANTS Population-based case-control study using the South Australian Myositis Database of all histologically confirmed cases of IIM diagnosed between 1990 and 2014 in patients 40 years or older (n = 221) and population-based controls from the North West Adelaide Health Study (n = 662), matched by age and sex in a 3:1 ratio of controls to cases. Data analysis using conditional logistic regression was performed from June 1, 2016, to July 14, 2017. EXPOSURES Current statin medication use. MAIN OUTCOMES AND MEASURES Unadjusted and adjusted (for diabetes and cardiovascular disease) odds ratios and 95% CIs for likelihood of inflammatory myositis. RESULTS A total of 221 IIM cases met the inclusion criteria with a mean (SD) age of 62.2 (10.8) years, and 132 (59.7%) were female. Statin exposure at the time of IIM diagnosis was 68 of 221 patients (30.8%) and 142 of 662 matched controls (21.5%) (P = .005). There was an almost 2-fold increased likelihood of statin exposure in patients with IIM compared with controls (adjusted odds ratio, 1.79; 95% CI, 1.23-2.60; P = .001). Similar results were observed when patients with necrotizing myositis were excluded from the analysis (adjusted odds ratio, 1.92; 95% CI, 1.29-2.86; P = .001). CONCLUSIONS AND RELEVANCE In this large population-based study, statin exposure was significantly associated with histologically confirmed IIM. Given the increased use of statins worldwide and the severity of IIM, increased awareness and recognition of this potentially rare adverse effect of statin exposure is needed.
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Affiliation(s)
- Gillian E Caughey
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, Australia.,School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Genevieve M Gabb
- General Medicine, Royal Adelaide Hospital, Adelaide, Australia.,Department of Medicine, University of Adelaide, Adelaide, Australia.,Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Australia
| | - Saffron Ronson
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Michael Ward
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Timothy Beukelman
- Division of Rheumatology, Department of Pediatrics, University of Alabama at Birmingham
| | - Catherine L Hill
- Department of Medicine, University of Adelaide, Adelaide, Australia.,Department of Rheumatology, The Queen Elizabeth Hospital, Woodville, Australia.,The Health Observatory, Discipline of Medicines, University of Adelaide, Adelaide, Australia.,Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Vidya Limaye
- Department of Medicine, University of Adelaide, Adelaide, Australia.,Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia
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Abstract
Statins are the Marmite ('You either love it or hate it!') of the drug world, both in terms of therapeutic benefit and risk of side effects. Proponents think that they are potential life-savers, opponents that their main benefit is lining the pockets of pharma. Some consider side effects to be a major issue, outweighing any therapeutic benefit, others that they are rare and essentially innocuous. Statin-induced myalgia is relatively common but often mild and for most people does not limit treatment. In others, reducing the dose or changing the preparation may help. In all, withdrawal of the statin leads to resolution. Statin-induced rhabdomyolysis, most often precipitated by drug-drug interaction, affects only a tiny proportion of statin users, but because of the widespread prescribing of statins is an important clinical problem. Statin-induced immune-mediated necrotising myopathy represents a novel disease mechanism and clinically mimics forms of myositis. Resolution often requires immunosuppressant drug treatment, as well as statin withdrawal.
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Domingo-Horne RM, Salajegheh MK. An Approach to Myopathy for the Primary Care Clinician. Am J Med 2018; 131:237-243. [PMID: 29074094 DOI: 10.1016/j.amjmed.2017.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 12/19/2022]
Abstract
Patients with muscle weakness are frequently encountered in the primary care clinic; however, the identification of an underlying disorder of muscle can pose a significant challenge. The aim of this review article is to provide a clinical and diagnostic framework to aid the primary care clinician in the detection and evaluation of suspected myopathies.
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Affiliation(s)
- Rose M Domingo-Horne
- VA Boston Healthcare System, Neurology Service/Division of Neuromuscular Medicine, Harvard Medical School, Boston, Mass
| | - Mohammad Kian Salajegheh
- VA Boston Healthcare System, Neurology Service/Division of Neuromuscular Medicine, Harvard Medical School, Boston, Mass.
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Selva-O'Callaghan A, Alvarado-Cardenas M, Pinal-Fernández I, Trallero-Araguás E, Milisenda JC, Martínez MÁ, Marín A, Labrador-Horrillo M, Juárez C, Grau-Junyent JM. Statin-induced myalgia and myositis: an update on pathogenesis and clinical recommendations. Expert Rev Clin Immunol 2018; 14:215-224. [PMID: 29473763 DOI: 10.1080/1744666x.2018.1440206] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Musculoskeletal manifestations are well-recognized side effects of treatment with statins. New advances in this field have appeared in recent years. This review focuses on the diagnosis of these conditions and their underlying pathogenesis, in particular immune-mediated necrotizing myopathy. Areas covered: Clinical phenotypes including rhabdomyolysis, myalgia and/or mild hyperCKemia, self-limited toxin statin myopathy, and immune-mediated necrotizing myopathy are herein described. Therapeutic recommendations and a diagnostic algorithm in statin-associated myopathy are also proposed. The etiology and pathogenesis of statin-induced myopathy has mainly focused on the anti-HMGCR antibodies and the responsibility of the immune-mediated necrotizing myopathy is discussed. The fact that patients who have not been exposed to statins may develop statin-associated autoimmune myopathy with anti-HMGCR antibodies is also addressed. The literature search strategy included terms identified by searches of PubMed between 1969 and December 2017. The search terms 'myositis', 'statin-induced autoimmune myopathy', 'immune-mediate necrotizing myopathy', 'statins', 'muscular manifestations', and 'anti-HMGCR antibodies' were used. Expert commentary: Full characterization of the known phenotypes of statin toxicity and the specific role of the anti-HMGCR in those exposed and not exposed (i.e. juvenile forms) to statins and in some types of neoplasms is of paramount relevance.
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Affiliation(s)
- Albert Selva-O'Callaghan
- a Systemic Autoimmune Diseases Unit, Vall d'Hebron General Hospital , Universitat Autonoma de Barcelona , Barcelona , Spain
| | - Marcelo Alvarado-Cardenas
- a Systemic Autoimmune Diseases Unit, Vall d'Hebron General Hospital , Universitat Autonoma de Barcelona , Barcelona , Spain
| | - Iago Pinal-Fernández
- b National Institutes of Health, Muscle Diseases , NIAMS , Bethesda , MD , USA.,c Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Ernesto Trallero-Araguás
- d Rheumatology Unit, Vall d'Hebron General Hospital , Universitat Autonoma de Barcelona , Barcelona , Spain
| | - José Cesar Milisenda
- e Internal Medicine Department, Hospital Clinic , Universitat de Barcelona , CIBERER , Barcelona , Spain
| | - María Ángeles Martínez
- f Immunology Department, Hospital de la Santa Creu i Sant Pau , Universitat Autonoma de Barcelona , Barcelona , Spain
| | - Ana Marín
- g Immunology Department, Vall d'Hebron General Hospital , Universitat Autonoma de Barcelona , Barcelona , Spain
| | - Moisés Labrador-Horrillo
- a Systemic Autoimmune Diseases Unit, Vall d'Hebron General Hospital , Universitat Autonoma de Barcelona , Barcelona , Spain.,g Immunology Department, Vall d'Hebron General Hospital , Universitat Autonoma de Barcelona , Barcelona , Spain
| | - Cándido Juárez
- f Immunology Department, Hospital de la Santa Creu i Sant Pau , Universitat Autonoma de Barcelona , Barcelona , Spain
| | - Josep María Grau-Junyent
- e Internal Medicine Department, Hospital Clinic , Universitat de Barcelona , CIBERER , Barcelona , Spain
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Khan NAJ, Khalid S, Ullah S, Malik MU, Makhoul S. Necrotizing Autoimmune Myopathy: A Rare Variant of Idiopathic Inflammatory Myopathies. J Investig Med High Impact Case Rep 2017; 5:2324709617709031. [PMID: 28660228 PMCID: PMC5476327 DOI: 10.1177/2324709617709031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/11/2017] [Accepted: 04/15/2017] [Indexed: 11/16/2022] Open
Abstract
Idiopathic inflammatory myopathies are an unusual group of myopathies with annual incidence of 1 in 100 000 people in the United States. Necrotizing autoimmune myopathy comprises only 16% of this group. It usually presents with severe proximal weakness, lower extremity weakness, and severe fatigue while very rarely does it present with dysphagia and respiratory muscle weakness. Statin use, cancer, and connective tissue disorder are the usual associated risk factors. Anti-signal recognition particle and 3-hydroxy-3-methylglutaryl-coenzyme A reductase are the 2 most common autoantibodies associated with necrotizing autoimmune myopathy. In this article, we present a very rare case of a 66-year-old male who presented with shortness of breath and dysphagia requiring intubation and ventilator support. Creatine kinase was 23 000, myoglobin was 7000, and ANA was positive. All other autoimmune and infectious workup including Lyme disease was unremarkable. Muscle biopsy turned out remarkable for necrotizing myopathy. No evidence of statin use, active malignancy, or connective tissue disease was found. He was treated with high-dose corticosteroids and a short course of intravenous immunoglobulin with very mild improvement in symptoms. Anti-signal recognition particle and 3-hydroxy-3-methylglutaryl-coenzyme A reductase could not be performed as the patient refused to pursue further medical testing. This is a very rare case of idiopathic inflammatory myopathy presenting with bulbar and respiratory muscle weakness requiring ventilator support.
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Affiliation(s)
- Noman Ahmed Jang Khan
- Temple University, Philadelphia, PA, USA.,Conemaugh Memorial Hospital, Johnstown, PA, USA
| | - Shaza Khalid
- Temple University, Philadelphia, PA, USA.,Conemaugh Memorial Hospital, Johnstown, PA, USA
| | - Saad Ullah
- Temple University, Philadelphia, PA, USA.,Conemaugh Memorial Hospital, Johnstown, PA, USA
| | - Muhammad Umair Malik
- Temple University, Philadelphia, PA, USA.,Conemaugh Memorial Hospital, Johnstown, PA, USA
| | - Samer Makhoul
- Temple University, Philadelphia, PA, USA.,Conemaugh Memorial Hospital, Johnstown, PA, USA
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MIOPATIA TÓXICA NÃO IMUNE E MIOPATIA NECROSANTE IMUNO‐MEDIADA APÓS ÚNICA DOSE DE SINVASTATINA. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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