Anti-HMGCR Myopathy

J Neuromuscul Dis. 2018;5(1):11-20. doi: 10.3233/JND-170282.


Anti-HMGCR myopathy was first recognized and characterized in patients with a history of statin exposure and immune-mediated necrotizing myopathy. After the discovery of anti-HMGCR autoantibodies, several international groups identified and characterized more patients, expanding the phenotypic spectrum of this disease to include pediatric patients and young adults without statin exposure and those with a chronic myopathy resembling limb-girdle muscular dystrophy. We provide a summary of clinical findings, pathologic features, muscle imaging, and immunogenetic risk factors of the disease. We also discuss the current treatment strategies and approaches to monitoring the therapeutic response. Lastly, we briefly summarize the current understanding of the pathophysiology of the disease and postulate a model for autoimmunity initiation and propagation in this disease.

Keywords: Anti-HMGCR myopathy; autoimmunity; limb-girdle muscular dystrophy; myositis; necrotizing myopathy.

Publication types

  • Review

MeSH terms

  • Autoantibodies / immunology*
  • Autoimmune Diseases / chemically induced
  • Autoimmune Diseases / drug therapy
  • Autoimmune Diseases / immunology*
  • Autoimmune Diseases / physiopathology
  • Humans
  • Hydroxymethylglutaryl CoA Reductases / immunology*
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects
  • Immunosuppressive Agents / therapeutic use
  • Muscular Diseases / chemically induced
  • Muscular Diseases / drug therapy
  • Muscular Diseases / immunology
  • Muscular Diseases / physiopathology
  • Myositis / chemically induced
  • Myositis / drug therapy
  • Myositis / immunology*
  • Myositis / physiopathology


  • Autoantibodies
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Immunosuppressive Agents
  • Hydroxymethylglutaryl CoA Reductases