Abstract
Statins might cause and/or aggravate the immune-mediated myositis in patients on long-term, stable treatment. We provide a case of polymyositis with an immunological background and gastrointestinal and urinary manifestations in patient on long-term, stable atorvastatin treatment for the past six years. The diagnose of polymyositis was established based on clinical symptoms and signs, electromyography and laboratory test results (elevated aspartate aminotransferase 279 U/L, reference range 0–40 U/L; alanine aminotransferase 198 U/L, 0–33 U/L; lactate dehydrogenase 2200 U/L, 103-227 U/L; creatine kinase 7820 U/L, 15–84 U/L; and positive antinuclear antibodies test, titer of 1:160, with suspect antisynthetase antibodies). Polymyositis was probably related to atorvastatin treatment (Naranjo score, 5). Other probable causes of the myositis were rejected. Coricosteroid therapy, methotrexate and supplementation with vitamin D did not improve the condition. The patient remained bedridden and died two months after the hospital discharge due to the acute myocardial infarction.
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References
Hmelin A., Turgeon J., Hydrophilicity/Lipophlicity: relevance for the pharmacology and clinical effects of HMG-CoA reductase inhibitors, Trends. Pharmacol. Sci., 1998, 19, 26–37
Todorovic Z., Nesic Z., Stojanović R., Basta-Jovanović G., Radojevic-Skodrić S., Velicković R., et al., Acute protective effects of simvastatin in the rat model of renal ischemia-reperfusion injury: it is never too late for the pretreatment, J. Pharmacol. Sci., 2008, 107, 465–470
Hoffman K.B., Kraus C., Dimbil M., Beatrice A. Golomb B. A., A survey of the FDA’s AERS database regarding muscle and adverse events linked to the statin drug class. http://plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0042866. (accessed 2013 Jan 31)
Radcliffe K. A., Campbell W. W., Statin myopathy, Curr. Neurol. Neurosci. Rep., 2008, 8, 66–72
Marcoff L., Thompson P., The Role of Coenzyme Q10 in Statin-Associated Myopathy, J. Am. Coll. Cardiol., 2007, 49, 2231–2237
Sathasivam S., Statin induced myotoxicity, Eur. J. Intern. Med., 2012, 23, 317–324
Padala S., Thompson P. D., Statins as a possible cause of inflammatory and necrotizing myopathies, Atherosclerosis., 2012, 222, 15–21
Marshall J. B., Kretschmar J. M., Gerhardt D. C., Winship D. H., Winn D., Treadwell E.L., et al., Gastrointestinal manifestations of mixed connective tissue disease, Gastroenterology, 1990, 98, 1232–1238
Dalakas M. C., Hohlfeld R., Polymyositis and dermatomyositis, Lancet, 2003, 362, 971–982
McKenney J. M., Dyslipidemias, atherosclerosis, and coronary heart disease, In: Koda-Kimble M. A (ed.), Applied therapeutics: the clinical use of drugs. 8th ed., Lippencott Williams & Wilkins, 2005
Hilton-Jones D., Myopathy associated with statin therapy, Neuromuscul. Disord., 2008, 18, 97–98
Naranjo C. A., Busto U., Sellers E. M., Sandor P., Ruiz I., Roberts E. A., et al., A method for estimating the probability of adverse drug reactions, Clin. Pharmacol. Ther., 1981, 30, 239–245
Anonymous. Real world drug outcomes, personalized. http://www.ehealthme.com/ds/Lipitor. (accessed 2013 Jan 15)
Glueck C. J., Abuchaibe C., Wang P., Symptomatic myositis-myalgia in hypercholesterolemic statintreated patients with concurrent vitamin D deficiency leading to statin intolerance may reflect a reversible interaction between vitamin D deficiency and statins on skeletal muscle, Med. Hypotheses, 2011, 77, 658–661
Transfeldt E. E., Morley J.E., Segal F., Klein A., Bill P., Fancourt M., Polymyositis as a cause of malabsorption, S. Afr. Med., J 1997, 51, 176–178
Mansell P. I., Tattersall R. B., Balsitis M., Lowe J., Spiller R.C., Megaduodenum due to hollow visceral myopathy successfully managed by duodenoplasty and feeding jejunostomy, Gut., 1991, 32, 334–337
Hughes A. J., Ferguson I., Rankin E., Kane K., Polymyositis as a cause of total gut failure, Ann. Rheum. Dis., 2002, 61, 305–306
Tzioufas A. G., 2001, Antisynthetase syndrome. https://www.orpha.net/data/patho/GB/uk-antisynthetase.pdf (accessed 2013 Feb 08)
Colglazier C. L., Sutej P. G., Laboratory testing in the rheumatic diseases: a practical review, South. Med. J., 2005, 98, 185–191
Mammen A. L., Chung T., Christopher-Stine L., Rosen P., Rosen A., Doering K.R., et al., Autoantibodies against 3-hydroxy-3-methylglutaryl-coenzyme A reductase in patients with statin-associated autoimmune myopathy, Arthritis Rheum., 2011, 63, 713–721
Christopher-Stine L., Casciola-Rosen L. A., Hong G., Chung T., Corse A. M., Mammen A. L., A novel autoantibody recognizing 200-kd and 100-kd proteins is associated with an immune-mediated necrotizing myopathy, Arthritis Rheum., 2010, 62, 2757–2766
Grable-Esposito P., Katzberg H. D., Greenberg S. A., Srinivasan J., Katz J., Amato A. A., Immunemediated necrotizing myopathy associated with statins, Muscle Nerve, 2010, 41, 185–190
Marie I., Morbidity and mortality in adult polymyositis and dermatomyositis, Curr Rheumatol Rep, 2012, 14, 275–285
Ng M.K., Celermajer D.S., Glucocorticoid treatment and cardiovascular disease, Heart, 2004, 90, 829–830
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Protić, D., Baltić, S., Stupar, N.V. et al. A case of myositis with immunological background associated with statin use. cent.eur.j.med 9, 619–624 (2014). https://doi.org/10.2478/s11536-013-0313-z
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DOI: https://doi.org/10.2478/s11536-013-0313-z