Increasing incidence of immune-mediated necrotizing myopathy: single-centre experience

Martin Klein, Heřman Mann, Lenka Pleštilová, Josef Zámečník, Zoe Betteridge, Neil McHugh, Jiří Vencovský

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Abstract

OBJECTIVES: Immune-mediated necrotizing myopathy (IMNM) is characterized by the predominant presence of necrotic muscle fibres in muscle biopsy and variable response to immunosuppressive treatment. The aims of this study were to analyse the temporal trend of IMNM incidence in our centre over the past 10 years and to explore the role of statins as possible causative agents.

METHODS: A retrospective evaluation of muscle biopsy results, clinical and laboratory data, including antibody associations of all patients with idiopathic inflammatory myopathy newly diagnosed between 2004 and June 2014, was performed. Available sera were tested for the presence of anti-3-hydroxy-3-methylglutaryl coenzyme A reductase (anti-HMGCR) autoantibodies.

RESULTS: Of 357 biopsied patients, 233 fulfilled criteria for inflammatory/immune-mediated myopathy, including 27 (11.6%) classified as IMNM. There were no patients with IMNM diagnosed between 2004 and 2007; subsequently, two to three cases of IMNM per year were seen during the period 2008-11, with a substantial increase to 18 cases (66.6% of all IMNM biopsies) in 2012-14. Thirteen of 27 patients (48%) had a history of statin use, 11 (85%) of whom had positive anti-HMGCR antibodies. There was no IMNM patient without a history of statin use who was anti-HMGCR antibody positive.

CONCLUSION: Our data show an increasing incidence of IMNM, which is mainly accounted for by anti-HMGCR-positive IMNM associated with the use of statins.

LanguageEnglish
Pages2010-2014
Number of pages5
JournalRheumatology
Volume54
Issue number11
Early online date24 Jun 2015
DOIs
StatusPublished - 6 Aug 2015

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Muscular Diseases
Incidence
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Oxidoreductases
Biopsy
Muscles
Antibodies
Myositis
Immunosuppressive Agents
Autoantibodies
3-hydroxy-3-methylglutaryl-coenzyme A

Cite this

Klein, M., Mann, H., Pleštilová, L., Zámečník, J., Betteridge, Z., McHugh, N., & Vencovský, J. (2015). Increasing incidence of immune-mediated necrotizing myopathy: single-centre experience. Rheumatology, 54(11), 2010-2014. https://doi.org/10.1093/rheumatology/kev229

Increasing incidence of immune-mediated necrotizing myopathy : single-centre experience. / Klein, Martin; Mann, Heřman; Pleštilová, Lenka; Zámečník, Josef; Betteridge, Zoe; McHugh, Neil; Vencovský, Jiří.

In: Rheumatology, Vol. 54, No. 11, 06.08.2015, p. 2010-2014.

Research output: Contribution to journalArticle

Klein, M, Mann, H, Pleštilová, L, Zámečník, J, Betteridge, Z, McHugh, N & Vencovský, J 2015, 'Increasing incidence of immune-mediated necrotizing myopathy: single-centre experience' Rheumatology, vol. 54, no. 11, pp. 2010-2014. https://doi.org/10.1093/rheumatology/kev229
Klein M, Mann H, Pleštilová L, Zámečník J, Betteridge Z, McHugh N et al. Increasing incidence of immune-mediated necrotizing myopathy: single-centre experience. Rheumatology. 2015 Aug 6;54(11):2010-2014. https://doi.org/10.1093/rheumatology/kev229
Klein, Martin ; Mann, Heřman ; Pleštilová, Lenka ; Zámečník, Josef ; Betteridge, Zoe ; McHugh, Neil ; Vencovský, Jiří. / Increasing incidence of immune-mediated necrotizing myopathy : single-centre experience. In: Rheumatology. 2015 ; Vol. 54, No. 11. pp. 2010-2014.
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abstract = "OBJECTIVES: Immune-mediated necrotizing myopathy (IMNM) is characterized by the predominant presence of necrotic muscle fibres in muscle biopsy and variable response to immunosuppressive treatment. The aims of this study were to analyse the temporal trend of IMNM incidence in our centre over the past 10 years and to explore the role of statins as possible causative agents.METHODS: A retrospective evaluation of muscle biopsy results, clinical and laboratory data, including antibody associations of all patients with idiopathic inflammatory myopathy newly diagnosed between 2004 and June 2014, was performed. Available sera were tested for the presence of anti-3-hydroxy-3-methylglutaryl coenzyme A reductase (anti-HMGCR) autoantibodies.RESULTS: Of 357 biopsied patients, 233 fulfilled criteria for inflammatory/immune-mediated myopathy, including 27 (11.6{\%}) classified as IMNM. There were no patients with IMNM diagnosed between 2004 and 2007; subsequently, two to three cases of IMNM per year were seen during the period 2008-11, with a substantial increase to 18 cases (66.6{\%} of all IMNM biopsies) in 2012-14. Thirteen of 27 patients (48{\%}) had a history of statin use, 11 (85{\%}) of whom had positive anti-HMGCR antibodies. There was no IMNM patient without a history of statin use who was anti-HMGCR antibody positive.CONCLUSION: Our data show an increasing incidence of IMNM, which is mainly accounted for by anti-HMGCR-positive IMNM associated with the use of statins.",
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AU - Klein, Martin

AU - Mann, Heřman

AU - Pleštilová, Lenka

AU - Zámečník, Josef

AU - Betteridge, Zoe

AU - McHugh, Neil

AU - Vencovský, Jiří

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N2 - OBJECTIVES: Immune-mediated necrotizing myopathy (IMNM) is characterized by the predominant presence of necrotic muscle fibres in muscle biopsy and variable response to immunosuppressive treatment. The aims of this study were to analyse the temporal trend of IMNM incidence in our centre over the past 10 years and to explore the role of statins as possible causative agents.METHODS: A retrospective evaluation of muscle biopsy results, clinical and laboratory data, including antibody associations of all patients with idiopathic inflammatory myopathy newly diagnosed between 2004 and June 2014, was performed. Available sera were tested for the presence of anti-3-hydroxy-3-methylglutaryl coenzyme A reductase (anti-HMGCR) autoantibodies.RESULTS: Of 357 biopsied patients, 233 fulfilled criteria for inflammatory/immune-mediated myopathy, including 27 (11.6%) classified as IMNM. There were no patients with IMNM diagnosed between 2004 and 2007; subsequently, two to three cases of IMNM per year were seen during the period 2008-11, with a substantial increase to 18 cases (66.6% of all IMNM biopsies) in 2012-14. Thirteen of 27 patients (48%) had a history of statin use, 11 (85%) of whom had positive anti-HMGCR antibodies. There was no IMNM patient without a history of statin use who was anti-HMGCR antibody positive.CONCLUSION: Our data show an increasing incidence of IMNM, which is mainly accounted for by anti-HMGCR-positive IMNM associated with the use of statins.

AB - OBJECTIVES: Immune-mediated necrotizing myopathy (IMNM) is characterized by the predominant presence of necrotic muscle fibres in muscle biopsy and variable response to immunosuppressive treatment. The aims of this study were to analyse the temporal trend of IMNM incidence in our centre over the past 10 years and to explore the role of statins as possible causative agents.METHODS: A retrospective evaluation of muscle biopsy results, clinical and laboratory data, including antibody associations of all patients with idiopathic inflammatory myopathy newly diagnosed between 2004 and June 2014, was performed. Available sera were tested for the presence of anti-3-hydroxy-3-methylglutaryl coenzyme A reductase (anti-HMGCR) autoantibodies.RESULTS: Of 357 biopsied patients, 233 fulfilled criteria for inflammatory/immune-mediated myopathy, including 27 (11.6%) classified as IMNM. There were no patients with IMNM diagnosed between 2004 and 2007; subsequently, two to three cases of IMNM per year were seen during the period 2008-11, with a substantial increase to 18 cases (66.6% of all IMNM biopsies) in 2012-14. Thirteen of 27 patients (48%) had a history of statin use, 11 (85%) of whom had positive anti-HMGCR antibodies. There was no IMNM patient without a history of statin use who was anti-HMGCR antibody positive.CONCLUSION: Our data show an increasing incidence of IMNM, which is mainly accounted for by anti-HMGCR-positive IMNM associated with the use of statins.

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