Clinical and genetic associations of autoantibodies to 3‐hydroxy‐3‐methyl‐glutaryl‐coenzyme a reductase in patients with immune‐mediated myositis and necrotizing myopathy |
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| Authors: | Vidya Limaye PhD Chris Bundell PhD Peter Hollingsworth DPhil Arada Rojana‐Udomsart MD PhD Frank Mastaglia MD Peter Blumbergs MBBS Sue Lester BSc |
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| Institution: | 1. Rheumatology Department, Royal Adelaide Hospital, North Tce, Adelaide, South Australia SA, Australia;2. Discipline of Medicine, Adelaide University, Adelaide, South Australia, Australia;3. PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia;4. Clinical ImmunologySir Charles Gairdner Hospital;5. West Australian Neuroscience Research Institute, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia;6. Rheumatology Department, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia |
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| Abstract: | Introduction: Inhibition of 3‐hydroxy‐3‐methyl‐glutaryl‐coenzyme A reductase (HMGCR) with statins may trigger idiopathic inflammatory myositis (IIM) or immune‐mediated necrotizing myopathy (IMNM). Anti‐HMGCR antibodies have been detected in patients with IIM/IMNM. We aimed to determine the associations of anti‐HMGCR in IIM/IMNM. Methods: Anti‐HMGCR antibodies were detected by ELISA in sera from patients with IIM/IMNM. Results: Anti‐HMGCR antibodies were detected in 19 of 207 patients with IIM/IMNM, and there was a trend toward an association with male gender (P = 0.079). Anti‐HMGCR antibodies were associated strongly with statin exposure (OR = 39, P = 0.0001) and HLA‐DRB1*11 (OR = 50, P < 0.0001). The highest risk for development of anti‐HMGCR antibodies was among HLA‐DR11 carriers exposed to statins. Univariate analysis showed a strong association of anti‐HMGCR antibodies with diabetes mellitus (P = 0.008), which was not confirmed by multiple regression. Among anti‐HMGCR+ patients there was a trend toward increased malignancy (P = 0.15). Conclusions: Anti‐HMGCR antibodies are seen in all subtypes of IIM and IMNM and are associated strongly with statin use and HLA‐DR11. Muscle Nerve 52 : 196–203, 2015 |
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| Keywords: | antibodies HMG‐CoA reductase immune‐mediated necrotizing myopathy muscle biopsy myositis statins |
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