Polymyositis, Dermatomyositis, and Statins: A Review

Mauro Turrin

DOI: https://doi.org/10.7175/cmi.v12i1.1364


BACKGROUND: Statins are a well-recognized cause of a variety of skeletal myopathic effects, which generally resolve when discontinuing the treatment. Among autoimmune manifestations associated with statins, there are typical polymyositis (PM) and typical dermatomyositis (DM).

OBJECTIVE: To perform a review on published case reports and case series about statin-associated PM and DM.

METHODS: This literature comprehensive search was conducted mainly on PubMed, but also congress abstracts and university websites were considered. Given the paucity of cases, the search was extended to include articles in all languages with English abstract.

RESULTS: Twenty-eight PM and 30 DM cases have been described with prevalence in female (64%) and senile age. The drugs most frequently involved were atorvastatin and simvastatin. The differential diagnosis should be made among the main myositis subtypes: immuno-mediated necrotizing myopathy (IMNM), inclusion body myositis (IBM), and overlap syndrome with myositis (OM), including anti-synthetase syndrome (ASS).

CONCLUSIONS: Even though the onset of polymyositis or dermatomyositis is a rare phenomenon, it is advisable to consider their presence in patients taking statins and with a non-reversible elevation of creatine phosphokinase.


Statins; Dermatomyositis; Polymyositis; Autoimmune Myositis

Full Text



  • Selva-O’Callaghan A, Alvarado-Cardenas M, Pinal-Fernández I, et al. Statin-induced myalgia and myositis: an update on pathogenesis and clinical recommendations. Expert Rev Clin Immunol 2018; 14: 215-24; https://doi.org/10.1080/1744666X.2018.1440206
  • Furst DE, Amato AA, Iorga SR, et al. Epidemiology of adult idiopathic inflammatory myopathies in a U.S. managed care plan. Muscle Nerve 2012; 45: 676-83; https://doi.org/10.1002/mus.23302
  • Kanth R, Shah MS, Flores RM. Statin-associated polymyositis following omeprazole treatment. Clin Med Res 2013; 11: 91-5; https://doi.org/10.3121/cmr.2012.1110
  • Fauchais AL, Iba Ba J, Maurage P, et al. Polymyositis induced or associated with lipid-lowering drugs: five cases. Rev Med Interne 2004; 25: 294-8; https://doi.org/10.1016/j.revmed.2003.10.013
  • Wu Y, Lach B, Provias JP, et al. Statin-associated autoimmune myopathies: a pathophysiologic spectrum. Can J Neurol Sci 2014; 41: 638-47; https://doi.org/10.1017/cjn.2014.22
  • Giordano N, Senesi M, Mattii G, et al. Polymyositis associated with simvastatin. Lancet 1997; 349: 1600-1; https://doi.org/10.1016/S0140-6736(05)61628-5
  • Riesco-Eizaguirre G, Arpa-Gutierrez FJ, Gutierrez M, et al. Severe polymyositis with simvastatin use. Rev Neurol 2003; 37: 934-6
  • Takagi A, Shiio Y. Pravastatin-associated polymyositis, a case report. Rinsho Shinkeigaku 2004; 44: 25-7
  • Folzenlogen D. A case of atorvastatin combined toxic myopathy and inflammatory myositis. J Clin Rheumatol 2001; 7: 340-5; https://doi.org/10.1097/00124743-200110000-00019
  • Sailler L, Pereira C, Bagheri A, et al. Increased exposure to statins in patients developing chronic muscle diseases: a 2-year retrospective study. Ann Rheum Dis 2008; 67: 614-9; https://doi.org/10.1136/ard.2007.075523
  • Padala S, Thompson PD. Statins as a possible cause of inflammatory and necrotizing myopathies. Atherosclerosis 2012; 22: 15-21; https://doi.org/10.1016/j.atherosclerosis.2011.11.005
  • Borges IBP, Silva MG, Misse RG, et al. Lipid-lowering agent-triggered dermatomyositis and polymyositis: a case series and literature review. Rheumatol Int 2018; 38: 293-301; https://doi.org/10.1007/s00296-017-3821-3
  • Watad A, Soriano A, Vaknine H, et al. Immune mediated myopathy following long-term statin therapy. Isr Med Assoc J 2015; 17: 128-9
  • Protić D, Baltić S, Stupar NV, et al. A case of myositis with immunological background associated with statin use. Cent Eur J Med 2014; 9: 619-24; https://doi.org/10.2478/s11536-013-0313-z
  • Horák T, Voháňka S, Tvrdíková, et al. Statin-induced necrotizing autoimmune myopathy. Cesk Slov Neurol N 2017; 80/113: 569-77; https://doi.org/10.14735/amcsnn2017569
  • Gupta S, Blaivas M, Ike RW, et al. Polymyositis evolving after rhabdomyolysis associated with HMG-CoA reductase inhibitors: a report of two cases. J Clin Rheumatol 2001; 7: 332-5; https://doi.org/10.1097/00124743-200110000-00015
  • Zaraa IR, Labbène I, Mrabet D, et al. Simvastatin-induced dermatomyositis in an 50-year-old-man. BMJ Case Rep 2011; 2011: bcr0220113832; http://dx.doi.org/10.1136/bcr.02.2011.3832
  • Komai I, Takemoto M, Yokote K. Atorvastatin-induced dermatomyositis in an 47-year-old woman with Sjögren’s syndrome. Acta Cardiol 2015; 70: 373; https://doi.org/10.1080/AC.70.3.3080648
  • Rasch A, Schimmer M, Sander CA. Simvastatin-induced dermatomyositis. Hautarzt 2009; 60: 483-9; https://doi.org/10.1007/s00105-008-1637-5
  • Vasconcelos OM, Campbell WW. Dermatomyositis-like syndrome and HMG-CoA reductase inhibitor (statin) intake. Muscle Nerve 2004; 30: 803-7; https://doi.org/10.1002/mus.20127
  • Noël B, Cerottini JP, Panizzon RG. Atorvastatin-induced dermatomyositis. Am J Med 2001; 110: 670-1; https://doi.org/10.1016/S0002-9343(01)00711-2
  • Zuech P, Pauwels C, Dulhoit C, et al. Pravastatin-induced dermatomyositis. Rev Med Interne 2005; 26: 897-902; https://doi.org/10.1016/j.revmed.2005.07.005
  • Khattak FH, Morris IM, Branford WA. Simvastatin-associated dermatomyositis. Br J Rheumatol 1994; 33: 199; https://doi.org/10.1093/rheumatology/33.2.199
  • Rodriguez-Garcia JL, Serrano Commino M. Lovastatin-associated dematomyositis. Postgrad Med J 1996; 72: 694; https://doi.org/10.1136/pgmj.72.853.694
  • Hill C, Zeitz C, Kirkham B. Dermatomyositis with lung involvement in a patient treated with simvastatin. Aust N Z J Med 1995; 25: 745-6; https://doi.org/10.1111/j.1445-5994.1995.tb02870.x
  • Thual N, Penven K, Chevalier JM, et al. Fluvastatin-induced dermatomyositis. Ann Dermatol Venereol 2005; 132: 996-9
  • Schalke BB, Achmidt B, Toyka K, et al. Pravastatin-associated inflammatory myopathy. N Engl J Med 1992; 327: 649-50; https://doi.org/10.1056/NEJM199208273270919
  • Inhoff O, Peitsch WK, Paredes BE, et al. Simvastatin-induced amyopathic dermatomyositis. Br J Dermatol 2009; 161: 206-8; https://doi.org/10.1111/j.1365-2133.2009.09205.x
  • Cannon CS. Statin-induced rhabdomyolysis and dermatomyositis: a rare combination. JAAPA 2012; 25: 30,32-3; https://doi.org/10.1097/01720610-201208000-00006
  • Fania L, Didona D, Tonanzi T, et al. Simvastatin-associated dermatomyositis. Dermatol Ther 2017; 30. Epub 2017 Mar 14. https://doi.org/10.1111/dth.12480
  • Oztas M, Ugurlu S, Aydin O. Atorvastatin-induced dermatomyositis. Rheumatol Int 2017; 37: 1217-9; https://doi.org/10.1007/s00296-017-3658-9
  • Chemello RML, Benvegnù AM, Dallazem LND, et al. Aggressive and fatal statin-induced dermatomyositis: a case report. Oxf Med Case Reports 2017; 12: 242-5; https://doi.org/10.1093/omcr/omx063
  • Tihanyi L, Sutô G, Veress G. Necrotising autoimmune myopathy showing dermatomyositis symptoms during persistent statin treatment. Lege Artis Medicinae 2013; 23: 113-6
  • Spiro J, Butts M. Atorvastatin-induced dermatomyositis: resolution with change in statin? JCR 2018; 24: 406-9; https://doi.org:110.10977/RHU.0000000000000709
  • Hydzik P, Szpak D. Side effects on the HMG-CoA reductase inhibitors (statins). Lupus erythematosus induced by atorvastatin therapy. Przegl Lek 2011; 68: 495-8
  • Bohan A, Peter JB. Polymyositis and dermatomyositis (first of two parts). N Engl J Med 1975; 292: 344-7; https://doi.org/10.1056/NEJM197502132920706; https://doi.org/10.1056/NEJM197502202920807
  • Bohan A, Peter JB. Polymyositis and dermatomyositis (second of two parts). N Engl J Med 1975; 292: 403-7; https://doi.org/10.1056/NEJM197502132920706; https://doi.org/10.1056/NEJM197502202920807
  • Hoogendijk JE, Amato AA, Lecky BR, et al. 119th ENMC international workshop: trial design in adult idiopathic inflammatory myopathies, with the exception of inclusion body myositis, 10-12 October 2003, Narden, The Netherlands. Neuromuscul Disord 2004; 14: 337-45; https://doi.org/10.1016/j.nmd.2004.02.006
  • Lundberg IE, Tjärnlund A, Bottai M, et al. 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Ann Rheum Dis 2017; 76: 1955-64; https://doi.org/10.1136/annrheumdis-2017-211468
  • Lilleker JB, Vencovsky J, Wang G, et al. The EuroMyositis registry: an international collaborative tool to facilitate myositis research. Ann Rheum Dis 2018; 77: 30-9; https://doi.org/10.1136/annrheumdis-2017-211868
  • Schmidt J. Current classification and management of inflammatory myopathies. J Neuromuscul Dis 2018; 5: 109-29; https://doi.org/10.3233/JND-180308
  • Selva-O’Callaghan A, Pinal-Fernández I, Trallero-Araguàs E, et al. Classification and management of adult inflammatory myopathies. Lancet Neurol 2018; 17: 816-28; https://doi.org/10.1016/S1474-4422(18)30254-0
  • Mariampillai K, Granger B, Amelin D, et al. Development of a new classification system for idiopathic inflammatory myopathies based on clinical manifestations and myositis-specific autoantibodies. JAMA Neurol 2018; Sep 10: E1-E10; https://doi.org/10.1001/jamaneurol.2018.2598
  • Pinal-Fernandez I, Casal-Dominguez M, Carrino JA, et al. Thigh muscle MRI in immune-mediated necrotising myopathy: extensive oedema, early muscle damage and role of anti-SRP autoantibodies as a marker of severity. Ann Rheum Dis 2016; 0: 1-7; http://dx.doi.org/10.1136/annrheumdis-2016-210198
  • Elessawy SS, Abdelsalam EM, Abdel RE, et al.Whole-body MRI for full assessment and characterization of diffuse inflammatory myopathy. Acta Radiol Open 2016; 5: 2058460116668216; https://doi.org/10.1177/2058460116668216
  • Huang ZG, Gao BX, Chen H, et al. An efficacy analysis of whole-body magnetic resonance imaging in the diagnosis and follow up of polymyositis and dermatomyositis. PLoSOne 2017; 12: e0181069; https://doi.org/10.1371/journal.pone.0181069
  • Pipitone N. Value of MRI in diagnostics and evaluation of myositis. Curr Opin Rheumatol 2016; 28: 62530; https://doi.org/10.1097/BOR.0000000000000326
  • Day J, Patel S, Limaye V. The role of magnetic resonance imaging techniques in evaluation and management of the idiopathic inflammatory myopathies. Semin Arthritis Rheum 2017; 46: 642-9; https://doi.org/10.1016/j.semarthrit.2016.11.001
  • Tomas X, Milisenda JC, Garcia-Diez AI, et al. Whole-body MRI and pathological findings in adult patients with myopathies. Skeletal Radiol 2018 Oct 30; [Epub ahead of print]; https://doi.org/10.1007/s00256-018-3107-1
  • Turrin M, Martinelli S. Statin-induced rhabdomyolysis: polymyositis/dermatomyositis or necrotizing autoimmune myopathy? Description of a clinical case in an elderly patient. G Ital Arterioscler 2017; 8: 83-8
  • Aggarwal R, Marder G, Koontz DC, et al. Efficacy and safety of adrenocorticotropic hormone gel in refractory dermatomyositis and polymoyositis. Ann Rheum Dis 2018; 77: 720-7; https://doi.org/10.1136/annrheumdis-2017-212047
  • Christopher-Stine L, Casciola-Rosen LA, Hong G, et al. A novel autoantibody recognizing 200-kd and 100-kd proteins is associated with an immune-mediated necrotizing myopathy. Arthritis Rheum 2010; 62: 2757-66; https://doi.org/10.1002/art.27572
  • Mammen AL, Chung T, Christopher-Stine A, et al. Autoantibodies against 3-hydroxy-3-metylglutaryl-coenzyme A reductase in patients with statin-associated autoimmune myopathy. Arthritis Rheum 2011; 63: 713-21; https://doi.org/10.1002/art.30156
  • Noël B. Lupus erythematosus and other autoimmune diseases related to statin therapy: a systematic review. J Eur Acad Dermatol Venereol 2007; 21: 17-24; https://doi.org/10.1111/j.1468-3083.2006.01838.x
  • Turrin M, Martinelli S. Drug-induced lupus: simvastatin or amiodarone? A case report in elderly. Clinical Management Issues 2013; 7: 17-26; https://doi.org/10.7175/cmi.v7i1.644
  • Lo Schiavo A, Puca RV, Romano F, et al. Pemphigus erythematosus relapse associated with atorvastatin intake. Drug Des Devel Ther 2014; 8: 1463-5; https://doi.org/10.2147/DDDT.S66666
  • Alonso JJ, Jaimez L, Sabio JM, et al. Atorvastatin-induced reversible positive antinuclear antibodies. Am J Med 2002; 112: 329-30; https://doi.org/10.1016/S0002-9343(01)01102-0
  • Caughey GE, Gabb GM, Ronson S, et al. Association of statin exposure with histological confirmed idiopathic inflammatory myositis in an Australian population. JAMA Intern Med 2018; 178: 1224-29; https://doi.org/10.1001/jamainternmed.2018.2859
  • Turrin M. Statins and immune-mediated necrotizing myopathy. Clinical Management Issues 2018; 12: 77-88; https://doi.org/10.7175/cmi.v12i1.1367
  • Mohassel P, Mammen AL. Statin-associated autoimmune myopathy and anti-HMGCR autoantibodies. Muscle Nerve 2013; 48: 477-83; https://doi.org/10.1002/mus.23854
  • Lavian M, Mozaffar T, Goyal N. Clinical dermatomyositis associated with anti-HMC-CoA reductase antibody positive immuno mediated necrotizing myopathy: a case report. Neurology 2017; 88 (16 supplement): P2.125
  • Parikh P, Tavee J, Soltanzadeh P, et al. Anti-3-hydroxy-3-methylglutaryl-coenzyme a reductase autoantibody-positive necrotizing autoimmune myopathy with dermatomyositis-like eruption. Muscle Nerve 2018; 57: E135-E136; https://doi.org/10.1002/mus.26072
  • Dixit A, Abrudescu A. A case of atorvastatin-associated necrotizing autoimmune myopathy, mimicking idiopathic polymyositis. Case Rep Rheumatol 2018; 2018: 5931046; https://doi.org/10.1155/2018/5931046
  • Mancini GB, Tashakkor AY, Baker S, et al. Diagnosis, prevention, and management of statin adverse effects and intolerance: Canadian Working Group Consensus update. Can J Cardiol 2013; 29: 1553-68; https://doi.org/10.1016/j.cjca.2013.09.023
  • Nguyen KA, Li L, Lu D, et al. A comprehensive review and meta-analysis of risk factors for statin-induced myopathy. Eur J Clin Pharmacol 2018; 74: 1099-109; https://doi.org/10.1007/s00228-018-2482-9
  • Turrin M, Tinello A. Hypercholesterolemia, hyperCKemia and macro-creatine kinase: a case report. Intern Emerg Med 2012: 7 (Suppl 4): 361. S552-S553; https://doi.org/10.1007/s11739-012-0888-4
  • Casciola-Rosen L, Hall JC, Mammen Al, et al. Isolated elevation of aldolase in the serum of myositis patients: a potential biomarker of damaged early regenerating muscle cells. Clin Exp Rheumatol 2012; 30: 548-53
  • Poli A, Barbagallo CM, Cicero A, et al. Nutraceuticals and functional foods for the control of plasma cholesterol levels. An Intersociety position paper. Pharmacol Res 2018; 134: 51-60; https://doi.org/10.1016/j.phrs.2018.05.015
  • Sabatine MS, Giugliano RP, Keech AC, et al. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med 2017; 376: 1713-22; https://doi.org/10.1056/NEJMoa1615664
  • Szarek M, White HD, Schwartz GG, et al.; ODYSSEY OUTCOMES Committees and Investigators. Alirocumab reduces total nonfatal cardiovascular and fatal events in the ODYSSEY OUTCOMES trial. J Am Coll Cardiol 2018 Oct 27. pii: S0735-1097(18)38961-7. [Epub ahead of print]; https://doi.org/10.1016/j.jacc.2018.10.039


Abstract: 3084 views
HTML: 982 views
PDF: 433 views


  • There are currently no refbacks.