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Med Forum teaching pearl thread 1/9
This clinical entity is different than just myalgias related to a statin...
This clinical entity is different than just myalgias related to a statin...
2/9
Myalgias are defined as aches, soreness, cramps, etc and have been documented in up to 5-10% of patients on statins...
Myalgias are defined as aches, soreness, cramps, etc and have been documented in up to 5-10% of patients on statins...
3/9
Although a 2014 systematic review and meta analysis suggested that mild musculoskeletal problems (including myalgias) occur in approximately equal number of persons treated with statins and those given placebos...
Although a 2014 systematic review and meta analysis suggested that mild musculoskeletal problems (including myalgias) occur in approximately equal number of persons treated with statins and those given placebos...
4/9
However, myalgias are just one part of the possible muscular adverse effects of statin therapy, and those further down on the list can have serious clinical manifestations...
However, myalgias are just one part of the possible muscular adverse effects of statin therapy, and those further down on the list can have serious clinical manifestations...
5/9
The most sinister is perhaps a (relatively) newly discovered clinical entity: statin-associated, autoimmune myopathy. The HMGCR ab was discovered in 2010 in Baltimore and is associated with myonecrosis...
ncbi.nlm.nih.gov/pubmed/20496415
The most sinister is perhaps a (relatively) newly discovered clinical entity: statin-associated, autoimmune myopathy. The HMGCR ab was discovered in 2010 in Baltimore and is associated with myonecrosis...
ncbi.nlm.nih.gov/pubmed/20496415
6/9
As a reminder, statins act by inhibiting HMG-CoA reductase ...
As a reminder, statins act by inhibiting HMG-CoA reductase ...
7/9
A proposed schematic is below which includes a perfect storm of immunogenic HLA alleles and other (proposed) mechanisms that could increase immunogenicity of HMGCR-derived peptides. Ultimately leads to sustained muscle injury...
ncbi.nlm.nih.gov/pmc/articles/P…
A proposed schematic is below which includes a perfect storm of immunogenic HLA alleles and other (proposed) mechanisms that could increase immunogenicity of HMGCR-derived peptides. Ultimately leads to sustained muscle injury...
ncbi.nlm.nih.gov/pmc/articles/P…
8/9
This sustained muscle injury leads to weakness and elevated CK levels even when OFF the statin, and often requires immunosuppressive therapy... (glucocorticoids, IVIG, MTX, mycophenolate, azathioprine, plasma exchange, and/or rituximab +others)
This sustained muscle injury leads to weakness and elevated CK levels even when OFF the statin, and often requires immunosuppressive therapy... (glucocorticoids, IVIG, MTX, mycophenolate, azathioprine, plasma exchange, and/or rituximab +others)
9/9
Finally, and surprisingly, recent data suggests that older patients may have a higher % chance of regaining strength (8+ on Kendall scale here)
END
Finally, and surprisingly, recent data suggests that older patients may have a higher % chance of regaining strength (8+ on Kendall scale here)
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