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Lipid-lowering agent-triggered dermatomyositis and polymyositis: a case series and literature review

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Abstract

Lipid-lowering agent-triggered dermatomyositis (DM) or polymyositis (PM) is a rare event. Therefore, the aim of the present study was to describe a series of such cases. A retrospective cohort study of 5 DM and 4 PM cases triggered by prior exposure to lipid-lowering agents between 2001 and 2017 was carried out. All patients, except for two cases, had muscle biopsy compatible with inflammatory myopathy and no serum autoantibodies positive for anti-SRP or anti-HMGCoAR. Median age of the patients at time of diagnosis was 68 years. Seven patients had previously taken simvastatin 20 mg/day (exposure period from 2 days to 4 years) and two bezafibrate 100 mg/day (3–4 months). Median time from symptom onset to disease diagnosis was 6 months. All patients with DM had a heliotrope and/or Gottron’s papules. All patients had symmetrical, predominantly proximal muscle weakness of limbs, with median serum creatine phosphokinase of 3087U/L (interquartile 25–75% range 1293–13,937 U/L). All patients received glucocorticoid and immunosuppressants. Complete reversal of clinical symptoms and normalization of serum creatine phosphokinase level occurred within a median of 12 months after starting the treatment. There was disease relapse in three cases, and one case of death was unrelated to the disease (pulmonary infectious complications resulting from lymphoma). In contrast to cases described in the literature, the patients in the present study had a relatively more aggressive course, requiring glucocorticoids and immunosuppressants, in addition to a tendency for a longer period to achieve disease remission.

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Funding

This study was funded by: Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) (#2015/12628-0) to I.B.P.B and (#2016/23574-0) to R.G.M.; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) to M.G.S.; Federico Foundation, Fundação Faculdade de Medicina, FAPESP (#2014/09079-1) to S.K.S.

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Authors and Affiliations

  1. Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil

    Isabela Bruna Pires Borges, Marilda Guimarães Silva, Rafael Giovane Misse & Samuel Katsuyuki Shinjo

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  1. Isabela Bruna Pires Borges
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  2. Marilda Guimarães Silva
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  3. Rafael Giovane Misse
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  4. Samuel Katsuyuki Shinjo
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Correspondence to Samuel Katsuyuki Shinjo.

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All authors declare no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The present study was approved by the local ethics committee.

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Borges, I.B.P., Silva, M.G., Misse, R.G. et al. Lipid-lowering agent-triggered dermatomyositis and polymyositis: a case series and literature review. Rheumatol Int 38, 293–301 (2018). https://doi.org/10.1007/s00296-017-3821-3

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  • DOI: https://doi.org/10.1007/s00296-017-3821-3

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