(See Table 1, p. 16, for a summary of metabolic myopathy classification.) Rhabdomyolysis is the rapid destruction of skeletal muscle resulting in leakage into the urine of the muscle protein myoglobin. The exact pathophysiology of statin-induced myopathy is not fully known. ... examined rhabdomyolysis in a hospital population, the average incidence per 10 000 person years for monotherapy with atorvastatin, pravastatin, or simva- Although the precise incidence is unknown, drug-induced myopathy is among the most common causes of muscle disease. There may be tea-colored urine or an irregular heartbeat. Rhabdomyolysis has many causes. Multiple pathophysiological mechanisms may contribute to statin myotoxicity. Exertional rhabdomyolysis is characterised by muscle breakdown associated with strenuous exercise or normal exercise under extreme circumstances. The metabolic myopathies are a heterogeneous group of disorders that share the common feature of inadequate production of cellular energy in the muscle. Harper CR, Jacobson TA. There are precisely zero RCTs showing benefit of any treatment for rhabdomyolysis. In addition, the diagnosis of mitochondrial myopathy requires a muscle biopsy, which some individuals may decline. 6. Next, the recently established necrotizing myopathy associated with statins is described. Chatzizisis Y, Koskinas K, Misirli G, et al. Recurrent episodes of rhabdomyolysis, including recurrent episodes of pigmenturia, are suggestive of muscle disease. Rhabdomyolysis is a riddle wrapped in a mystery inside an enigma. Medications can cause muscle injury and rhabdomyolysis. Drug Saf. Rhabdomyolysis can cause muscle pain and weakness. Generally we think of statin rhabdomyolysis as an acute, crisis reaction causing immediate hospitalization and aggressive therapy. Rhabdomyolysis is a potentially life-threatening syndrome resulting from the breakdown of skeletal muscle fibers with leakage of muscle contents into … 8. Some of the muscle breakdown products, such as the protein myoglobin, are harmful to the kidneys and may lead to kidney failure.. A family history of rhabdomyolysis may also indicate presence of an inherited myopathy. Drug-induced myopathy ranges from mild myalgias with or without mild weakness to chronic myopathy with severe weakness and to massive rhabdomyolysis with acute renal failure [].Over 150 agents have been associated with rhabdomyolysis []. INTRODUCTION. The circumstances triggering rhabdomyolysis, such as a viral illness or fasting, may also indicate the presence of an inherited myopathy. Rhabdomyolysis is the most severe adverse effect of statins, which may result in acute renal failure, disseminated intravascular coagulation and death. myopathy and its management in the light of recent epidemiological studies, randomised controlled trials, and guidelines. Symptoms may include muscle pains, weakness, vomiting, and confusion. The definition of rhabdomyolysis is debatable, specifically regarding which level of creatinine kinase (if any) predicts renal injury. Curr Opin Lipidol. Key features are severe muscle pain and sudden transient elevation of serum creatine kinase (CK) levels with or without associated myoglobinuria. The first section discusses the very common myalgias, myopathies, and rare rhabdomyolysis occurring with statin use. 2007;18:401-408. This review focuses on a number of them. Risk factors and drug interactions predisposing to statin-induced myopathy. Rhabdomyolysis is a condition in which damaged skeletal muscle breaks down rapidly. The broad spectrum of statin myopathy: from myalgia to rhabdomyolysis. 7. Mitochondrial myopathies can be difficult to diagnose; included in the differential diagnoses are myositis, dermatomyositis, rhabdomyolysis, electrolyte abnormality, thyroid disease, Guillain-Barré syndrome, and myasthenia gravis. Mild cases may remain unnoticed or undiagnosed. 2010;33:171-187. Although I have long suspected a low-grade myopathy can be triggered by statin therapy and persist thereafter, this is the first rather dramatic evidence that this condition may not only occur but may be quite common.
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