• Carola Maria Gagliardo, Davide Noto, Antonina Giammanco, Silvia Maltese, Luca Vecchio, Giuseppe Lavatura, Valentina Cacciatore, Carlo Maria Barbagallo, Antonina Ganci, Emilio Nardi, Marcello Ciaccio, Rosalia Lo Presti, Angelo Baldassare Cefalù, and Maurizio Averna.
• Department of Health Promotion, Maternal and Child Health, Internal and Specialized Medicine of Excellence "G. D. Alessandro" (PROMISE), University of Palermo, Street: Via del Vespro 127, 90127, Palermo, Italy.
• Intern Emerg Med. 2023 Jun 1; 18 (4): 109511071095-1107.

AbstractStatin-induced autoimmune myositis (SIAM) represents a rare clinical entity that can be triggered by prolonged statin treatment. Its pathogenetic substrate consists of an autoimmune-mediated mechanism, evidenced by the detection of antibodies directed against the 3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR Ab), the target enzyme of statin therapies. To facilitate the diagnosis of nuanced SIAM clinical cases, the present study proposes an "experience-based" diagnostic algorithm for SIAM. We have analyzed the clinical data of 69 patients diagnosed with SIAM. Sixty-seven patients have been collected from the 55 available and complete case records regarding SIAM in the literature; the other 2 patients represent our direct clinical experience and their case records have been detailed. From the analysis of the clinical features of 69 patients, we have constructed the diagnostic algorithm, which starts from the recognition of suggestive symptoms of SIAM. Further steps provide for CK values dosage, musculoskeletal MR, EMG/ENG of upper-lower limbs and, Anti-HMGCR Ab testing and, where possible, the muscle biopsy. A global evaluation of the collected clinical features may suggest a more severe disease in female patients. Atorvastatin proved to be the most used hypolipidemic therapy.© 2023. The Author(s).

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