TY - JOUR T1 - Treatment of Refractory Anti-HMG-CoA Reductase Myopathy: A Role for Rituximab? JF - The Journal of Rheumatology JO - J Rheumatol SP - 550 LP - 551 DO - 10.3899/jrheum.181392 VL - 46 IS - 6 AU - ANDREW L. MAMMEN Y1 - 2019/06/01 UR - http://www.jrheum.org/content/46/6/550.abstract N2 - Anti-hydroxymethylglutaryl CoA reductase (HMGCR) myopathy is a subtype of myositis characterized by proximal muscle weakness, elevated serum creatine kinase (CK) levels, and autoantibodies recognizing HMGCR1. While statins are an established risk factor for developing anti-HMGCR myopathy in older patients, some individuals develop this condition without a known statin exposure2,3. To date, effective treatment strategies have not been established in clinical trials. Nonetheless, many patients with anti-HMGCR myopathy improve with immunosuppressive therapy, and current expert opinion guidelines recommend initiating treatment with corticosteroids, methotrexate, and/or intravenous immunoglobulin (IVIG)1. Unfortunately, a significant number of patients with anti-HMGCR myopathy have persistently active disease despite aggressive treatment with these and other agents. Indeed, a study including 50 patients with anti-HMGCR myopathy treated for 2 years or more found that 30% continued to have weakness and elevated muscle enzymes4. This underscores the importance of finding more effective treatment modalities for these patients.A number of observations suggest the possibility that autoantibodies may play a pathogenic role in anti-HMGCR myopathy. For example, anti-HMGCR titers have been … Address correspondence to Dr. A.L. Mammen, National Institutes of Health, 50 South Drive, Room 1141, Building 50, MSC 8024, Bethesda, Maryland 20892, USA. E-mail: andrew.mammen{at}nih.gov. ER -