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| {{CMG}}; {{AE}} [[User:Rim Halaby|Rim Halaby]] | | {{CMG}}; {{AE}} [[User:Rim Halaby|Rim Halaby]] |
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| ==Overview==
| | {{Statin induced myopathy}} |
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| ==Definition== | | ==[[Statin induced myopathy overview|Overview]]== |
| Statin induced myopathy is a spectrum of muscular problems caused by the intake of statin. Myopathy by definition is the abnormal function of the muscle. | |
| The spectrum of statin induced myopathy includes:
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| ====Myalgia====
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| * Myalgia is defined as one or combination of muscle weakness, tenderness or pain.
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| * Patients usually complain of cramping feeling in the muscles.
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| * Creatine kinase may be normal or minimally elevated.
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| ====Asymptomatic increase in creatine kinase==== | | ==[[Statin induced myopathy classification|Classification]]== |
| ====Myositis====
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| * Myositis is the inflammation of the muscle characterised by muscular complaints in the setting of elevated creatine kinase up to ten folds.
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| ====Rhabdomyositis==== | | ==[[Statin induced myopathy pathophysiology|Pathophysiology]]== |
| * Rhabdomyositis is the acute degeneration of the skeletal muscle.
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| * It is a potentially lethal condition due to its associated nephrotoxicity caused by myoglobinuria and myoglobinemia.
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| * Creatine kinase is elevated in rhabdomyosistis similarly to myositis.
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| * The complications of rhabdomyositis are acute tubular necrosis, hypocalcemia, hyperkalemia, metabolic acidosis, hyperuricemia, DIC and cardiomyopathy.<ref name="baker">Baker, S.K. & Tarnopolsky, M.A. (2001). Statin myopathies: pathophysiologic and clinical perspectives. Clin. Invest. Med., 24(5): 258-272.</ref>
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| ====Other Statin Induced Myopathies==== | | ==[[Statin induced myopathy epidemiology and demographics|Epidemiology & Demographics]]== |
| * Elevated creatine kinase after statin withdrawal<ref name="pmid12672737">{{cite journal| author=Thompson PD, Clarkson P, Karas RH| title=Statin-associated myopathy. | journal=JAMA | year= 2003 | volume= 289 | issue= 13 | pages= 1681-90 | pmid=12672737 | doi=10.1001/jama.289.13.1681 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12672737 }} </ref>
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| * Autoimmune myopathy requiring immunosuppressive therapy<ref name="pmid18367041">{{cite journal| author=Radcliffe KA, Campbell WW| title=Statin myopathy. | journal=Curr Neurol Neurosci Rep | year= 2008 | volume= 8 | issue= 1 | pages= 66-72 | pmid=18367041 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18367041 }} </ref>
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| ==Prevalence== | | ==[[Statin induced myopathy epidemiology and demographics|Risk Factors]]== |
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| ==Risk Factors== | | ==[[Statin induced myopathy screening|Screening]]== |
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| ==Pathophysiology== | | ==[[Statin induced myopathy differential diagnosis|Differentiating Statin induced myopathy from other Diseases]]== |
| Statin induced myopathies has a complex poorly understood multifactorial pathophysiology. It is postulated that statin causes myopathy through the following changes: | |
| * Changes in cholesterol content and alteration of the membrane fluidity of skeletal muscle cells which disrupts their normal function
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| * Changes in skeletal muscle cells membrane electrical properties
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| * Changes in Na+/K+ pump density resulting in decreased production of ATP
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| * Changes in the excitation-contraction coupling
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| * Changes in the cell surface receptor transduction cascades
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| * Decreased synthesis of ubiquinone (Q10), a component of the mitochondrial electron transport chain, leading to decreased ATP production and decreased free radical scavenging
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| * Increased intracellular calcium causing apoptosis of the skeletal muscle cells
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| * Decreased mevalonate metabolism products, particularly isoprenoids, leading to a chain of events that culminate in apoptosis of skeletal muscle cells<ref name="pmid16885396">{{cite journal| author=Dirks AJ, Jones KM| title=Statin-induced apoptosis and skeletal myopathy. | journal=Am J Physiol Cell Physiol | year= 2006 | volume= 291 | issue= 6 | pages= C1208-12 | pmid=16885396 | doi=10.1152/ajpcell.00226.2006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16885396 }} </ref>
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| | ==Diagnosis== |
| | [[Statin induced myopathy history and symptoms|History & Symptoms]] | [[Statin induced myopathy laboratory tests|Lab Tests]] |
| ==Treatment== | | ==Treatment== |
| | [[Statin induced myopathy medical therapy|Medical Therapy]] |
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
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| | [[Category:Cardiology]] |
| | [[Category:Drugs]] |
| | [[Category:Disease]] |
| | [[Category:Up-To-Date cardiology]] |
| | [[Category:Up-To-Date]] |