Pediatric necrotizing myopathy associated with anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase antibodies

Wen-Liang Chen, Akinori Uruha, Shigeaki Suzuki, Nobuyuki Murakami, Eri Takeshita, Wan-Zi Chen, Yuh-Jyh Jong, Yukari Endo, Hirofumi Komaki, Tatsuya Fujii, Yutaka Kawano, Madoka Mori-Yoshimura, Yasushi Oya, Jianying Xi, Wenhua Zhu, Chongbo Zhao, Yurika Watanabe, Keisuke Ikemoto, Atsuko Nishikawa, Kohei HamanakaSatomi Mitsuhashi, Norihiro Suzuki, Ichizo Nishino

研究成果: Article同行評審

30 引文 斯高帕斯(Scopus)

摘要

Objective. Antibodies against 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) have recently been associated with immune-mediated necrotizing myopathy, especially in patients with statin exposure. As the data are very limited concerning phenotypes and treatment in paediatric patients, we aimed to identify the paediatric patients positive for anti-HMGCR antibodies and clarify their features and therapeutic strategies.

Methods. We screened 62 paediatric patients who were clinically and/or pathologically suspected to have inflammatory myopathy for anti-HMGCR antibodies. We further re-assessed the clinical and histological findings and the treatment of the patients positive for anti-HMGCR antibodies.

Results. We identified nine paediatric patients with anti-HMGCR antibodies (15%). This was more frequent than anti-signal recognition particle antibodies (four patients, 6%) in our cohort. The onset age ranged from infancy to 13 years. Five patients were initially diagnosed with muscular dystrophy, including congenital muscular dystrophy. Most patients responded to high-dose corticosteroid therapy first but often needed adjuvant immunosuppressants to become stably controlled.

Conclusion. Paediatric necrotizing myopathy associated with anti-HMGCR antibodies may not be very rare. Phenotypes are similar to those of adult patients, but a chronic slowly progressive course may be more frequent. Some patients share the clinicopathological features of muscular dystrophy indicating that recognizing inflammatory aetiology would be challenging without autoantibody information. On the other hand, most patients responded to treatment, especially those who were diagnosed early. Our results suggest the importance of early autoantibody testing in paediatric patients who have manifestations apparently compatible with muscular dystrophy in addition to those who have typical features of inflammatory myopathy.
原文English
頁(從 - 到)287-293
頁數7
期刊Rheumatology
56
發行號2
DOIs
出版狀態Published - 二月 2017

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