Clinical and persistent remission in anti-HMGCR immune-mediated necrotizing myopathy to a single cycle of rituximab - a case-based review.

IF 1.4 4区 医学 Q3 RHEUMATOLOGY
ARP Rheumatology Pub Date : 2024-07-01 DOI:10.63032/ZVNO7794
Susana P Silva, Gisela Eugénio, Miguel Pinto, Anabela Barcelos
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引用次数: 0

Abstract

Anti-HMGCR myopathy is an increasingly recognized immune-mediated necrotizing myopathy. However, there are currently no evidence-based treatments available, so case reports and clinical experience are used to guide current management. We report a case of a 49-year-old man, treated with atorvastatin, who presented to the emergency department with progressive proximal muscle weakness. Anti-HMGCR antibodies were detected, and muscle biopsy revealed necrotizing myopathy. Initially, therapy with high-dose glucocorticoids and methotrexate was started, but 12 weeks later, the patient developed clinical deterioration with dysphagia. Then, he was successfully treated with one cycle of rituximab along with physical therapy. The use of rituximab in immune-mediated necrotizing myopathy has been heterogeneously described in the literature but mostly in case reports. The European Neuromuscular Centre working group recommends the use of rituximab in refractory cases. However, some studies highlight the importance of early and aggressive treatment for this disease. Clinical prospective studies are necessary to make proper evidence-based recommendations.

抗-HMGCR免疫介导的坏死性肌病一个周期的临床和持续缓解--基于病例的回顾。
抗-HMGCR肌病是一种日益得到认可的免疫介导的坏死性肌病。然而,目前尚无循证治疗方法,因此病例报告和临床经验被用来指导当前的治疗。我们报告了一例使用阿托伐他汀治疗的 49 岁男性病例,他因进行性近端肌无力到急诊科就诊。检测到抗 HMGCR 抗体,肌肉活检发现了坏死性肌病。起初,患者开始接受大剂量糖皮质激素和甲氨蝶呤治疗,但12周后,患者出现吞咽困难,临床症状恶化。随后,他接受了一个周期的利妥昔单抗治疗和物理治疗,并取得了成功。关于利妥昔单抗在免疫介导的坏死性肌病中的应用,文献中的描述不尽相同,但大多是病例报告。欧洲神经肌肉中心工作组建议在难治性病例中使用利妥昔单抗。然而,一些研究强调了早期积极治疗的重要性。有必要进行临床前瞻性研究,以提出适当的循证建议。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
1.20
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