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Antibody levels correlate with creatine kinase levels and strength in anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase-associated autoimmune myopathy.
Arthritis Rheum. 2012 Dec; 64(12):4087-93.AR

Abstract

OBJECTIVE

Autoantibodies recognizing 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) are found in patients with statin-associated immune-mediated necrotizing myopathy and, less commonly, in statin-unexposed patients with autoimmune myopathy. The main objective of this study was to define the association of anti-HMGCR antibody levels with disease activity.

METHODS

Anti-HMGCR levels, creatine kinase (CK) levels, and strength were assessed in anti-HMGCR-positive patients. Associations of antibody level with CK level and strength at visit 1 were analyzed in 55 patients, 40 of whom were exposed to statins. In 12 statin-exposed and 5 statin-unexposed patients with serum from 5 serial visits, the evolution of antibody levels, CK levels, and strength was investigated.

RESULTS

Antibody levels were associated with CK levels (P < 0.001), arm strength (P < 0.05), and leg strength (P < 0.05) at visit 1, but these associations were only significant among statin-exposed patients in stratified analyses. With immunosuppressive treatment over 26.2 ± 12.6 months (mean ± SD), antibody levels declined (P < 0.05) and arm abduction strength improved (P < 0.05) in the 17 patients followed up longitudinally. The separate analysis showed that statin-exposed patients developed decreased antibody levels (P < 0.01), decreased CK levels (P < 0.001), improved arm strength (P < 0.05), and improved hip flexion strength (P < 0.05) with treatment. Anti-HMGCR antibody levels did not normalize in any patient.

CONCLUSION

In the entire cohort, initial anti-HMGCR levels correlated with indicators of disease activity; with immunosuppressive treatment, antibody levels declined and arm strength improved. Statin-exposed patients had significant improvements in CK levels and strength whereas statin-unexposed patients did not, suggesting a phenotypic difference between statin-exposed and statin-unexposed anti-HMGCR-positive patients.

Authors+Show Affiliations

Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

22933019

Citation

Werner, Jessie L., et al. "Antibody Levels Correlate With Creatine Kinase Levels and Strength in Anti-3-hydroxy-3-methylglutaryl-coenzyme a Reductase-associated Autoimmune Myopathy." Arthritis and Rheumatism, vol. 64, no. 12, 2012, pp. 4087-93.
Werner JL, Christopher-Stine L, Ghazarian SR, et al. Antibody levels correlate with creatine kinase levels and strength in anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase-associated autoimmune myopathy. Arthritis Rheum. 2012;64(12):4087-93.
Werner, J. L., Christopher-Stine, L., Ghazarian, S. R., Pak, K. S., Kus, J. E., Daya, N. R., Lloyd, T. E., & Mammen, A. L. (2012). Antibody levels correlate with creatine kinase levels and strength in anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase-associated autoimmune myopathy. Arthritis and Rheumatism, 64(12), 4087-93. https://doi.org/10.1002/art.34673
Werner JL, et al. Antibody Levels Correlate With Creatine Kinase Levels and Strength in Anti-3-hydroxy-3-methylglutaryl-coenzyme a Reductase-associated Autoimmune Myopathy. Arthritis Rheum. 2012;64(12):4087-93. PubMed PMID: 22933019.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antibody levels correlate with creatine kinase levels and strength in anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase-associated autoimmune myopathy. AU - Werner,Jessie L, AU - Christopher-Stine,Lisa, AU - Ghazarian,Sharon R, AU - Pak,Katherine S, AU - Kus,Jordan E, AU - Daya,Natalie R, AU - Lloyd,Thomas E, AU - Mammen,Andrew L, PY - 2012/04/12/received PY - 2012/08/09/accepted PY - 2012/8/31/entrez PY - 2012/8/31/pubmed PY - 2013/4/3/medline SP - 4087 EP - 93 JF - Arthritis and rheumatism JO - Arthritis Rheum VL - 64 IS - 12 N2 - OBJECTIVE: Autoantibodies recognizing 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) are found in patients with statin-associated immune-mediated necrotizing myopathy and, less commonly, in statin-unexposed patients with autoimmune myopathy. The main objective of this study was to define the association of anti-HMGCR antibody levels with disease activity. METHODS: Anti-HMGCR levels, creatine kinase (CK) levels, and strength were assessed in anti-HMGCR-positive patients. Associations of antibody level with CK level and strength at visit 1 were analyzed in 55 patients, 40 of whom were exposed to statins. In 12 statin-exposed and 5 statin-unexposed patients with serum from 5 serial visits, the evolution of antibody levels, CK levels, and strength was investigated. RESULTS: Antibody levels were associated with CK levels (P < 0.001), arm strength (P < 0.05), and leg strength (P < 0.05) at visit 1, but these associations were only significant among statin-exposed patients in stratified analyses. With immunosuppressive treatment over 26.2 ± 12.6 months (mean ± SD), antibody levels declined (P < 0.05) and arm abduction strength improved (P < 0.05) in the 17 patients followed up longitudinally. The separate analysis showed that statin-exposed patients developed decreased antibody levels (P < 0.01), decreased CK levels (P < 0.001), improved arm strength (P < 0.05), and improved hip flexion strength (P < 0.05) with treatment. Anti-HMGCR antibody levels did not normalize in any patient. CONCLUSION: In the entire cohort, initial anti-HMGCR levels correlated with indicators of disease activity; with immunosuppressive treatment, antibody levels declined and arm strength improved. Statin-exposed patients had significant improvements in CK levels and strength whereas statin-unexposed patients did not, suggesting a phenotypic difference between statin-exposed and statin-unexposed anti-HMGCR-positive patients. SN - 1529-0131 UR - https://www.unboundmedicine.com/medline/citation/22933019/Antibody_levels_correlate_with_creatine_kinase_levels_and_strength_in_anti_3_hydroxy_3_methylglutaryl_coenzyme_A_reductase_associated_autoimmune_myopathy_ L2 - https://doi.org/10.1002/art.34673 DB - PRIME DP - Unbound Medicine ER -