Internal Medicine: Open Access
Open Access

Management of myositis in a DGH setting- A tricky conundrum

2^nd International Conference on Internal Medicine & Hospital Medicine

September 13-14, 2017 Dallas, USA

Ashutosh Kapoor

Wansbeck General Hospital, UK

Posters & Accepted Abstracts: Intern Med

Abstract :

Introduction: Over half of all adults in the UK and 106.7 million Americans suffer from hypercholesterolemia. As a result, these individuals are at increased risk for atherosclerosis, stroke and heart disease. Current NICE guidelines recommend lifestyle modifications and statin therapy for the treatment of dyslipidemia and coronary artery disease (CAD). Statins have consistently been shown to reduce cardiovascular related mortality and morbidity through the reduction of low density lipoproteins (LDL). This has led to a trend of increased statin usage over the past two decades, represented in Canada whereby usage rates rose from 1.6% in 1994 to 7.8% in 2002. 2004, approximately 24 million Americans were taking statin medications. Case Study: A 74 year-old gentleman, who was generally fit and healthy, with a background history of Ischaemic Heart Disease and Hypertension, presented to Emergency Department with the following symptoms: Generally unwell, decreased mobility and proximal muscle weakness. All the symptoms commenced since the last three months. At that point, he reported inability to walk upstairs or lift heavy objects. He had to pick up her legs to get out of the car. He denied any fever, chills, weight loss, anorexia, joint pain, dysphagia, Raynaud's phenomenon, skin rash, and heat or cold intolerance. Medications on admission were Amlodipine, Ramipril and Atorvastatin. Investigations: Laboratory studies showed significantly elevated creatine phosphokinase (CPK) of 12,802 units/L (normal range 40�¢����320 units/L) with normal thyroid-stimulating hormone of 1.9 ���µIU/mL (normal range 0.5�¢����5.0 ���µIU/mL) and erythrocyte sedimentation rate of 19 (normal<20). Electromyography was performed on right upper and lower extremities and showed myopathic changes in the deltoid, hip flexors, and extensors. Post Statin- cessation, the levels of CK came down to 6463, but still significantly elevated. Power in lower limbs displayed gradual improvement as well. The echocardiogram-no obvious cardiomyopathy, anti-ENA antibodies=negative (includes Ro, La, RNP/Sm, Sm, Jo-1, Scl-70 and CEN-P) Anti-Ro52 antibodies=negative anti-PL-12 antibodies=negative anti-PL-7 antibodies=negative anti-Jo1 antibodies=negative anti-PMScl antibodies=negative anti-Ku antibodies=negative anti-Mi-2 antibodies=negative, nerve conduction studies done- pattern suggestive of inflammatory myositis - inclusion body/ antibody negative polymyositis, OGD/ colonoscopy-malignancy ruled out and muscle biopsy(freeman hospital) - biopsy done on vastus lateralis muscle-myopathic process with necrosis and regeneration, of likely autoimmune etiology. Statin induced/antibody negative polymyositis. Conclusion: NICE recommends that preventative treatment for cardiovascular disease (CVD) should be halved from a 20 per cent risk of developing the disease over 10 years to a 10 per cent risk. Rituximab can be considered in refractory cases. Further controlled studies are needed to define the optimal treatment approach. In conclusion this case, could finally be defined as a combination of Inflammatory Myositis, with a component of Statin induced Myopathy as a supplement.

Biography :

Ashutosh Kapoor completed schooling education joined the prestigious Kasturba Medical College, Manipal, in India. He graduated in 2012, following which he completed internship in Sir Gangaram Hospital, New Delhi, a reputed hospital, which has an extremely internship friendly program, with many research opportunities. It was always his dream to pursue Post Graduation from a country with sound training and robust work culture, to attain more exposure and enhance my skills, which is what, attracted him to the United Kingdom, wherein He pursued PLAB examinations (Medical Licensing Examinations) and obtained a License to Practice, following which he cleared the MRCP 1 and MRCP 2. Following this, He attended Core Medical Training Program, which he successfully managed to do in August, 2016 and he is currently pursuing the same. His Primary interest and motivation now lies in giving back to the society, what it has bestowed upon him and to follow his dream of becoming a Diabetes and Endocrine Consultant, one day in the future.