Thread by @rheum_cat

.@DrLisaCS on statin myopathy

autoimmune necrotizing myopathy vs self limited toxic myopathy -- learn this table!

#ACR22 #ReviewCourse

@DrLisaCS 🔑 difficulty swallowing seen in autoimmune myopathy
🔑 autoimmune version can occur years after statin start

🔑 the Ab is important and helpful for dx

🔑 If you stop the statin and CK still ⬆️⬆️it's almost always the autoimmune version

#ACR22 #ReviewCourse

Consensus for statin associated muscle sxs (SAMS)?? #ACR22 #Reviewcourse

Lipophilic vs hydrophilic statins, does it matter? Data suggests no

#ACR22 #ReviewCourse

Statin compliance is poor (~50% adherence in studies).
Why? Intolerance!

👉Make sure to r/o hypothyroidism

👉Make sure you understand the DDIs with statins

#ACR22 #Reviewcourse

What do we understand about exercise, statins, and CK?

We don't understand enough.

#ACR22 #Reviewcourse

SAMSON trial:
🔍nocebo effect (more sxs if you know you are on statin?)
🔍n of 1 trial (person serves as their own control)

👉empty bottle, low sx severity score
👉no sx difference btw statin & pbo; but this was lower than if empty bottle

#ACR22 #Reviewcourse

Another n of 1 statin trial, STATINWISE

👉didn't detect difference in muscle sxs between statin and pbo

Good data to decide if ok to restart/rechallenge statins!

Rechallenge does not apply to those with HMG-COA reductase Ab ❗️

#ACR22 #Reviewcourse

Quick points:

👉Ok to use statins in other neumomuscular disorders

👉Muscle bx for statin myopathy? Not needed. Esp don't do it if acute rhabdo

👉Check CK at statin start: No need

#ACR22 #ReviewCourse

Check CK if ⬆️LFTs

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Clinical recs for statin intolerance?

💡Take away statin & wait & reassess
💡Try your own n of 1 with rechallenge

Intolerance despite this? See cards guidelines
#ACR22 #Reviewcourse

What about CoQ10?

Statins ⬇️CoQ10 but no clear dose response

Small RCT: CoQ10 improved perception of sxs in pts with prior statin intolerance

Party line? May work, may not. Only harm is $

#ACR22 #Reviewcourse

8 (!) arm RCT of supplements: SPORT

Bottom line: no supplement lowered LDL greater than PBO

#ACR22 #ReviewCourse

Some of my favorite speakers deliver content faster than I can type, and that pantheon includes @AlexisOgdie & @kidneydoc101 😂

#ACR22