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If something looks like an apple, is it necessarily an apple? - reflections on so-called "statin-induced polymyalgia

Ciro Manzo1

  • 1Internal and Geriatric Medicine Department, Rheumatologic Outpatient Clinic Hospital "Mariano Lauro", Sant'Agnello, Italy.

Reumatologia
|August 30, 2019
PubMed

Insights

Polymyalgia rheumatica (PMR) is not caused by statins; these are distinct conditions. Ultrasound can differentiate true PMR from statin-induced symptoms, which may worsen existing PMR.

Area of Science:

  • Rheumatology
  • Pharmacology

Background:

  • Polymyalgia rheumatica (PMR) is an inflammatory condition.
  • Statins are commonly prescribed cholesterol-lowering drugs.
  • Some researchers have suggested a link between statin use and PMR.

Purpose of the Study:

  • To review the evidence for statin-induced polymyalgia rheumatica.
  • To differentiate between PMR and statin-associated muscle symptoms (SAMS).

Main Methods:

  • Literature review of existing studies and clinical observations.
  • Discussion of diagnostic criteria for PMR and SAMS.
  • Emphasis on the role of ultrasound (US) in differential diagnosis.

Main Results:

  • There is no convincing evidence to support the existence of statin-induced PMR.
  • PMR and SAMS are distinct clinical entities with different underlying mechanisms.
  • Ultrasound of the shoulder and hip can aid in distinguishing between true PMR and PMR-like symptoms from statins.

Conclusions:

  • The hypothesis of statin-induced PMR is not supported by current evidence.
  • Clinicians should consider SAMS as a potential factor in patients with PMR, especially if symptoms worsen or relapse without clear justification.
  • Discontinuation of statin therapy may be considered in such cases.
Keywords:
methodologypolymyalgia rheumaticapolymyalgia rheumatica-mimicking illnessstatins

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