Sintomatología muscular asociada a estatinas: ¿mito o realidad? / Statin-associated muscle symptoms: Myth or reality?

La sintomatología muscular asociada con estatinas es una entidad que engloba una constelación de diversas manifestaciones clínicas de distinta gravedad. Desde la introducción de las primeras estatinas se han publicado numerosos estudios acerca de su incidencia, fisiopatología, diagnóstico y tratamiento; sin embargo, a día de hoy estos aspectos siguen generando controversia. Con el aumento progresivo del uso de estatinas en la población general se han multiplicado las notificaciones de reacciones adversas relacionadas con su uso, particularmente las relacionadas con la toxicidad muscular. No obstante, las diferencias existentes entre los estudios publicados tanto en metodología como en resultados obtenidos hacen de esta relación un tema complejo y de gran interés para el clínico y los pacientes. La integración de la evidencia de la que disponemos actualmente puede ayudarnos a comprender mejor esta entidad y facilitar su manejo en la práctica clínica (AU)

Statin-associated muscle symptoms is an entity that encompasses a constellation of various clinical manifestations of variyng severity. Since the introduction of the first statins, numerous studies have been published regarding its incidence, pathophysiology, diagnosis and treatment; however, to this day these aspects are still controversial. With the progressive increase in the use of statins in the general population, notifications of adverse reactions related to its use have multiplied, particularly those related to muscular toxicity. Nevertheless, the differences between the published studies, both in methodology and in the results obtained, make this relationship a complex issue of great interest for clinicians and patients. The integration of the evidence that we currently have can help us understand better this entity and facilitate its management in clinical practice (AU)

Statin-associated muscle symptoms: Myth or reality?

Statin-associated muscle symptoms is an entity that encompasses a constellation of various clinical manifestations of variyng severity. Since the introduction of the first statins, numerous studies have been published regarding its incidence, pathophysiology, diagnosis and treatment; however, to this day these aspects are still controversial. With the progressive increase in the use of statins in the general population, notifications of adverse reactions related to its use have multiplied, particularly those related to muscular toxicity. Nevertheless, the differences between the published studies, both in methodology and in the results obtained, make this relationship a complex issue of great interest for clinicians and patients. The integration of the evidence that we currently have can help us understand better this entity and facilitate its management in clinical practice.

Principales miopatías: aproximación clínica, diagnóstico y manejo / Main myopathies: clinical approach, diagnosis and management

Myopathies make up an entity that, although rare, can have great clinical significance. These diseases can present a somewhat complex clinical and therapeutic approach due to the etiological versatility and the concomitant symptoms that can sometimes exist. The role of the clinical interview and physical examination is crucial in guiding our diagnostic suspicion. This article will present, in the first instance, the general approach to any type of myopathy in order to request the complementary tests required; and secondly, the clinical characteristics and entities that make up the main groups of myopathies, as well as their therapeutic approach. (AU)

Las miopatías conforman una entidad que, aunque poco frecuente, pueden tener gran trascendencia clínica. Estas pueden presentar un abordaje clínico y terapéutico algo complejo debido a la versatilidad etiológica y a la clínica concomitante que en ocasiones puede existir. El papel de la entrevista clínica y la exploración física es crucial de cara a orientar nuestra sospecha diagnóstica. Dentro del presente artículo se presentará, en primera instancia, el abordaje general de cualquier tipo de miopatía de cara a solicitar las pruebas complementarias requeridas; y en segundo lugar, las características clínicas y las entidades que conforman los principales grupos de miopatías, así como su abordaje terapéutico. (AU)

Enfermedad pulmonar intersticial como manifestación inicial de síndrome antisintetasa / Interstitial lung disease as initial manifestation of anti-synthetase syndrome

Se reporta el caso de un paciente que presentó un síndrome antisintetasa en el cual la miopatía fue precedida por EPID grave de instalación rápida y buena respuesta al manejo inmunosupresor con corticosteroides, ciclofosfamida y azatioprina. El cuadro clínico inicial con fiebre, infiltrados pulmonares, SDRA y ausencia de miopatía fue muy sugestivo de infección.Palabras clave: miopatía inflamatoria, enfermedad pulmonar intersticial, síndrome antisintetasa.

We report a patient with antisintetase síndrome with rapid and progressive interstitial difuse pulmonary disease preceding the muscular weakness. The patient was successfully treated with steroids, cyclophosphamide and azathioprine. The initial compromise: fever, dispnoea and pulmonary infiltrates without miopathy was misdiagnosed as pneumonia.Key words: inflamatory miopathy, interstitial pulmonary disease, antisintetase syndrome.

Intoxicação acidental por monensina em ovinos no Estado do Rio de Janeiro / Accidental monensin poisoning in sheep in Rio de Janeiro State

Descreve-se um surto de intoxicação por monensina em ovinos no Estado do Rio de Janeiro, no qual de 180 animais, oito morreram após serem alimentados com ração contendo o ionóforo. A enfermidade, de evolução variável, caracterizou-se clinicamente por apatia, arritmia cardíaca, mioglobinúria, incoordenação, incapacidade de se levantar, decúbito esternal; uma ovelha abortou. As lesões macroscópicas consistiram de áreas pálidas no miocárdio, hidroperitônio, hidrotórax e edema pulmonar. O exame histopatológico evidenciou alterações degenerativo-necróticas no coração e na musculatura esquelética. No miocárdio, as lesões eram mais marcadas e caracterizavam-se por necrose multifocal com substituição das miofibras por tecido conjuntivo fibroso e inflamação intersticial mononuclear. Adicionalmente, verificaram-se proliferação de células satélite e reação inflamatória mononuclear em músculos esqueléticos. Ao que tudo indica, a adição excessiva de monensina sódica, talvez associada à homogeneização inadequada da droga ao alimento, tenha determinado a ingestão de grande quantidade de monensina por parte dos animais.

An outbreak of monensin poisoning in sheep in the State of Rio de Janeiro is described. From 180 animals, eight died after they had been fed with ration containing the ionophore. The poisoning had a variable course and was clinically characterized by apathy, heart arrhythmia, myoglobinuria, incoordenation, incapacity of getting up, and sternal decubitus; one sheep aborted. The macroscopic lesions consisted of pale areas in the myocardium, hydroperitoneum, hydrothorax, and pulmonary edema. Histopathological examination revealed degenerative-necrotic alterations in heart and skeletal muscles. In the myocardium lesions were more severe and were characterized by multifocal necrosis with substitution of the myofibres by fibrous tissue and interstitial mononuclear infiltration. Proliferation of satellite cells and mononuclear inflammatory reaction in skeletal muscles were also verified. It seems that the exaggerated addition of sodic monensin, eventually associated with improper homogenization of monensin in the ration, was responsible for the excessive ingestion of monensin by some animals.