Polymyositis induced or associated with lipid-lowering drugs: five cases

Rhabdomyolysis and myositis are rare, dose-related complications of statins and fenofibrates. The outcome is favorable as a rule with rapid regression after stopping the responsible drug. Recently, various auto-immune disease with evidence of hypersensitivity to HMG-CoA reductase inhibitors or fibra...

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Bibliographic Details
Published in:La revue de medecine interne 2004-04, Vol.25 (4), p.294
Main Authors: Fauchais, A-L, Iba Ba, J, Maurage, P, Kyndt, X, Bataille, D, Hachulla, E, Parent, D, Queyrel, V, Lambert, M, Michon Pasturel, U, Hatron, P-Y, Vanhille, P, Devulder, B
Format: Article
Language:fre
Subjects:
Aged
Antibodies, Antinuclear - analysis
Female
Fenofibrate - adverse effects
Fenofibrate - therapeutic use
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Hypercholesterolemia - drug therapy
Hypolipidemic Agents - adverse effects
Hypolipidemic Agents - therapeutic use
Male
Middle Aged
Polymyositis - chemically induced
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Summary:Rhabdomyolysis and myositis are rare, dose-related complications of statins and fenofibrates. The outcome is favorable as a rule with rapid regression after stopping the responsible drug. Recently, various auto-immune disease with evidence of hypersensitivity to HMG-CoA reductase inhibitors or fibrates drugs have been reported. Less than ten cases of dermatomyositis and polymyositis due to cholesterol-lowering drugs (CLD) have been previously reported. Five more cases polymyositis associated with CLD are reported. Symptoms were compatible with diagnosis of polymyositis according to Bohan and Peter and with previous reported criteria for drug-induced myopathy in all cases. None of these patients had previous other connective tissue disorders. Five patients (median age 68 [54-78], female N =4) with CLD treatment (statin N =4, fenofibrates N =1) have developed iatrogenic polymyositis. All of them presented both proximal muscular weakness and increased muscle enzyme levels. One patient had iatrogenic antisynthetase syndrome characterized by mechanic's hand, Raynaud's phenomenon and anti JO1 antibodies. One other had sclerodermic hand oedema. Antinuclear antibodies were positive in 4 cases and muscle biopsy revealed polymyositis infiltrate in 4 cases. CLD treatment was discontinued with partial clinical improvement in 3 cases. Clinical remission was obtained with corticosteroid (N =5) in association with immunosuppresive agents in 3 cases. Muscular symptoms in patient with CLD treatment could be the first symptom of a polymyositis revealed or increased by this treatment and must encourage physician with antinuclear antibodies screening especially in case of proximal muscular weakness and increased muscle enzyme levels.
ISSN:0248-8663
1768-3122
DOI:10.1016/j.revmed.2003.10.013