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Prieto-Peña D, Ocejo-Vinyals JG, Mazariegos-Cano J, Pelayo-Negro AL, Remuzgo-Martínez S, Genre F, García-Dorta A, Renuncio-García M, Martínez-Taboada VM, García-Ibarbia C, Sánchez-Martín J, López-Hoyos M, Blanco R, González-Gay MA, Hernández JL. Epidemiological and genetic features of anti-3‑hydroxy-3-methylglutaryl-CoA reductase necrotizing myopathy: Single-center experience and literature review. Eur J Intern Med 2022; 101:86-92. [PMID: 35487805 DOI: 10.1016/j.ejim.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To characterize the demographic, genetic, clinical, and serological features of patients with anti-3‑hydroxy-3-methylglutaryl-CoA reductase (HMGCR) immune-mediated necrotizing myopathy (IMNM) in a region of northern Spain. METHODS Study of all patients diagnosed with anti-HMGCR IMNM during a 5-year period at a reference hospital in northern Spain. Besides clinical and laboratory data, we analyzed the genetic influence of HLA genes and the rs4149056 (c.521T>C) single nucleotide polymorphism (SNP) in the SLCO1B1 gene. RESULTS 8 patients (5 women, 3 men) with a mean ± SD age of 64.9 ± 7.3 years, fulfilled the criteria for anti-HMGCR IMNM. The incidence rate was 0.6 per 100.000 person-years and the prevalence 3 per 100.000 population. All patients had been exposed to statins. All of them had predominant lower limb proximal and symmetric muscle weakness that was severe in 2 and had elevated serum CK levels with a median [IQR] of 4488 [2538-9194] IU/L. Serum 25‑hydroxy vitamin D levels were decreased in all patients in whom it was determined. The 3 patients with a previous diagnosis of hypothyroidism had abnormal levels of TSH at the time of diagnosis. All patients experienced improvement with different schemes of immunosuppressive therapy. Noteworthy, 7 of 8 patients carried the HLA-DRB1*11 allele. The frequency of the rs4149056 C allele in the SLCO1B1 gene (12.5%) was similar to that of the general population. CONCLUSION In northern Spain, anti-HMGCR IMNM preferentially affects people over 50 years of age who are carriers of the HLA-DRB1*11 allele and take statins. Both low vitamin D levels and hypothyroidism may play a potential predisposing role in the development of this disease.
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Affiliation(s)
- Diana Prieto-Peña
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Santander, Spain.
| | - Javier G Ocejo-Vinyals
- Department of Immunology, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Joel Mazariegos-Cano
- Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ana L Pelayo-Negro
- Department of Neurology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Sara Remuzgo-Martínez
- Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Santander, Spain
| | - Fernanda Genre
- Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Santander, Spain
| | - Alicia García-Dorta
- Department of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain
| | - Mónica Renuncio-García
- Department of Immunology, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Víctor M Martínez-Taboada
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain; University of Cantabria, Santander, Spain
| | - Carmen García-Ibarbia
- Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Julio Sánchez-Martín
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Santander, Spain
| | - Marcos López-Hoyos
- Department of Immunology, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain; University of Cantabria, Santander, Spain
| | - Ricardo Blanco
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Santander, Spain
| | - Miguel A González-Gay
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Santander, Spain; University of Cantabria, Santander, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - José L Hernández
- Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Santander, Spain; Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain; University of Cantabria, Santander, Spain.
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