{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T17:53:46Z","timestamp":1757613226524,"version":"3.44.0"},"reference-count":10,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Pract Neurol"],"accepted":{"date-parts":[[2018,1,14]]},"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:p>Statins lower serum cholesterol concentrations by inhibiting the enzyme 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR). Muscle side effects are relatively common and include asymptomatic elevation of serum creatine kinase (CK), myalgia, proximal muscle weakness and rhabdomyolysis. More recently, a subset of cases of immune-mediated necrotising myopathy has been found to have antibodies against HMGCR. It is often an aggressive and debilitating myopathy and has a complex pathogenesis characterised by fibre necrosis, usually with minimal associated inflammation. Not all such patients are taking statins. The general consensus is that best treatment involves withdrawing the statin and giving immunosuppressive and immunomodulatory treatment. We describe three cases of HMGCR-related immune-mediated necrotising myopathy, detailing their clinical course and subsequent management, illustrating the spectrum of this disorder.<\/jats:p>","DOI":"10.1136\/practneurol-2017-001848","type":"journal-article","created":{"date-parts":[[2018,2,12]],"date-time":"2018-02-12T11:09:11Z","timestamp":1518433751000},"page":"151-155","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Autoimmune necrotising myopathy and HMGCR antibodies"],"prefix":"10.1136","volume":"18","author":[{"given":"Kushan","family":"Karunaratne","sequence":"first","affiliation":[{"name":"Department of Neurology, Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitri","family":"Amiras","sequence":"additional","affiliation":[{"name":"Department of Radiology, Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew C","family":"Pickering","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monika","family":"Hofer","sequence":"additional","affiliation":[{"name":"Department of Neuropathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stuart","family":"Viegas","sequence":"additional","affiliation":[{"name":"Department of Neurology, Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,2,8]]},"reference":[{"key":"2025090411250552000_18.2.151.1","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s00393-015-0029-3","article-title":"Immune-mediated necrotizing myopathy","volume":"75","author":"Bergua","year":"2016","journal-title":"Z Rheumatol"},{"key":"2025090411250552000_18.2.151.2","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1097\/BOR.0000000000000335","article-title":"Spectrum of immune-mediated necrotizing myopathies and their treatments","volume":"28","author":"Pinal-Fernandez","year":"2016","journal-title":"Curr Opin Rheumatol"},{"key":"2025090411250552000_18.2.151.3","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1016\/j.autrev.2016.07.023","article-title":"Anti-HMGCR antibodies as a biomarker for immune-mediated necrotizing myopathies: A history of statins and experience from a large international multi-center study","volume":"15","author":"Musset","year":"2016","journal-title":"Autoimmun Rev"},{"key":"2025090411250552000_18.2.151.4","doi-asserted-by":"publisher","DOI":"10.1002\/art.27572"},{"key":"2025090411250552000_18.2.151.5","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1056\/NEJMra1515161","article-title":"Statin-associated autoimmune myopathy","volume":"374","author":"Mammen","year":"2016","journal-title":"N Engl J Med"},{"key":"2025090411250552000_18.2.151.6","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/aww054"},{"key":"2025090411250552000_18.2.151.7","doi-asserted-by":"crossref","unstructured":"Shovman O , Gilburd B , Chayat C , et al . Anti-HMGCR antibodies demonstrate high diagnostic value in the diagnosis of immune-mediated necrotizing myopathy following statin exposure. Immunol Res 2016.","DOI":"10.1007\/s12026-016-8867-x"},{"key":"2025090411250552000_18.2.151.8","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-210198"},{"key":"2025090411250552000_18.2.151.9","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1007\/s11926-015-0548-6","article-title":"Immune-mediated necrotizing myopathy: update on diagnosis and management","volume":"17","author":"Basharat","year":"2015","journal-title":"Curr Rheumatol Rep"},{"key":"2025090411250552000_18.2.151.10","doi-asserted-by":"crossref","first-page":"1680","DOI":"10.1056\/NEJMc1506163","article-title":"Intravenous immune globulin for statin-triggered autoimmune myopathy","volume":"373","author":"Mammen","year":"2015","journal-title":"N Engl J Med"}],"container-title":["Practical Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/practneurol-2017-001848","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T18:25:15Z","timestamp":1757010315000},"score":1,"resource":{"primary":{"URL":"https:\/\/pn.bmj.com\/lookup\/doi\/10.1136\/practneurol-2017-001848"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2,8]]},"references-count":10,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2018,3,27]]},"published-print":{"date-parts":[[2018,4]]}},"alternative-id":["10.1136\/practneurol-2017-001848"],"URL":"https:\/\/doi.org\/10.1136\/practneurol-2017-001848","relation":{},"ISSN":["1474-7758","1474-7766"],"issn-type":[{"type":"print","value":"1474-7758"},{"type":"electronic","value":"1474-7766"}],"subject":[],"published":{"date-parts":[[2018,2,8]]}}}