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Neurol Neuroimmunol Neuroinflamm. 2016 Oct 7;3(6):e290. eCollection 2016 Dec.

Cancer association as a risk factor for anti-HMGCR antibody-positive myopathy.

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Department of Neurology and Anti-aging Medicine (M.K., K. Kaida), National Defense Medical College, Saitama; Department of Neurology (A.H., K.T., C.I., N.U., A.K., S.K., S.T., J.S.), Graduate School of Medicine, The University of Tokyo; Department of Neurology (M.H.M., Y.U.), Toranomon Hospital; Division of Rheumatology (Y.M.), Department of Internal Medicine, Showa University School of Medicine, Tokyo; Pulmonary Medicine and Clinical Immunology (K. Kurasawa), Dokkyo Medical University, Tochigi; Department of Diagnostic and Interventional Radiology (H.S.), Osaka City University, Graduate School of Medicine; Department of Neurology (M.S.), Teikyo University School of Medicine; Department of Neurology (A.C.), Kyorin University; Department of Neurology (Y. Shiio), Tokyo Teishin Hospital; Division of Neurology (Y. Sakurai), Mitsui Memorial Hospital, Tokyo; Department of Neurology (T.I.), Tsukazaki Memorial Hospital, Hyogo; and AXA Department of Health and Human Security, Graduate School of Medicine (M.I.), The University of Tokyo, Japan.



To show cancer association is a risk factor other than statin exposure for anti-3-hydroxy-3-methylglutaryl coenzyme A reductase autoantibody-positive (anti-HMGCR Ab+) myopathy.


We analyzed the clinical features and courses of 33 patients (23 female and 10 male) with anti-HMGCR Ab+ myopathy among 621 consecutive patients with idiopathic inflammatory myopathies.


Among the 33 patients, 7 (21%) were statin-exposed and 26 were statin-naive. In relation with cancer, there were 12 patients (statin-exposed, n = 4) with cancers detected within 3 years of myopathy diagnosis (cancer association), 3 patients (all statin-naive) with cancers detected more than 3 years before myopathy diagnosis (cancer history), 10 cancer-free patients followed up for more than 3 years (all statin-naive), and 8 patients without cancer detection but followed up for less than 3 years (statin-exposed, n = 3). Therefore, 12 patients with cancer association (36%) formed a larger group than that of 7 statin-exposed patients (21%). Among 12 patients with cancer association, 92% had cancer detection within 1 year of myopathy diagnosis (after 1.3 years in the remaining patient), 83% had advanced cancers, and 75% died of cancers within 2.7 years. Of interest, 1 patient with cancer history had sustained increase in creatine kinase level over 12 years from cancer removal to the development of weakness.


Patients with cancer association formed a large group with poor prognosis in our series of patients with anti-HMGCR Ab+ myopathy. The close synchronous occurrence of cancers and myopathies suggested that cancer association is one of the risk factors for developing anti-HMGCR Ab+ myopathy.

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