Toksične miopatije

master's thesis

• Title (english): Toxic myopathies
• Author: Ines Jelenić
• Mentor: Ervina Bilić (mentor)
• Committee member: Marija Žagar (predsjednik povjerenstva)
• Committee member: Mario Habek (član povjerenstva)
• Committee member: Ervina Bilić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Neurology); Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Neurology

Abstract

Toksične miopatije su primarne bolesti mišića kod kojih je prvenstveno zahvaćen i promijenjen skeletni mišić, uzrokovane štetnim djelovanjem tvari koje se unose u organizam. Najčešće se radi o lijekovima, no toksične miopatije mogu biti uzrokovane i drugim tvarima iz okoliša bolesnika. Najčešća toksična miopatija je statinska miopatija uzrokovana uzimanjem lijekova sa ciljem snižavanja koncentracije kolesterola, tzv. statina. Statini su strukturni analozi HMG-CoA (3-hidroskimetil-3metilglutaril-konezim A)koji dovode do djelomične inhibicije enzima HMG-CoA-reduktaze te samim time i inhibicije prvog koraka u biosintezi sterola. Najjači učinak statina vidljiv je u snizivanju razine LDL kolesterola u krv. Klinički pokusi pokazali su da liječenje statinima značajno smanjuje učestalost novih koronarnih događaja i aterosklerotskih moždanih udara. U predstavnike statina ubrajamo lovastatin, atorvastatin, fluvastatin, pravastatin, simvastatin i rosuvastatin. Pod nazivom statinska miopatija podrazumijeva se pojava bilo kojeg mišićnog simptoma za vrijeme provođenja terapije statinima (sa ili bez porasta razine kreatin kinaze u serumu) koji se povlači po prekidu davanja lijeka. Glavne kliničke prezentacije statinske miopatije su asimptomatsko povišenje razine kreatin kinaze u serumu, pojava mialgije karakterizirane mišićnom slabošću, bolovima, grčevima, ukočenošću ili pojačanim mišićnim zamorom i nastanak rabdomiolize. Dijagnoza statinima uzrokovane miopatije temelji se pretežno na anamnestičkim podacima, kliničkim i laboratorijskim nalazima. Prvi korak u liječenju statinske miopatije je prekid terapije statinima uz zbrinjavanje pridruženih simptoma te primjena pomoćnih tvari kao što su koenzim Q10 i vitamin D. Druga po učestalosti toksična miopatija je steroidima uzrokovana miopatija. Učestalost razvoja miopatije ovisi o trajanju kortikosteroidne terapije, primijenjenoj dozi kao i o vrsti primijenjenog lijeka. Steroidima uzrokovana miopatija se tipično pojavljuje u dva oblika – akutnom i kroničnom obliku. Glavni pristup liječenju steroidima uzrokovane miopatije je smanjenje terapijske doze ili potpuni prekid terapije kortikosteroidima.

Abstract (english)

Toxic myopathies are muscular diseases that are referring to specific clinical disorders of the skeletal muscles as a result of the underlying toxic etiology. Most frequently, the primary cause of the toxic myopathy is drug usage. Other causative factors may include enviromental toxins. Cholesterol lowering medications, particularly the statins, are the most commonly prescribed drugs that cause toxic myopathy. Statins are structural inhibitors of the 3-hydroxy-3-methylglutaryl coenzym A reductase (HMGCR). Their main mechanism of action is to inhibit the function of the HMGCR, which is the rate-limiting enzyme in the cholesterol biosynthesis. By reducing the serum levels of low-density lipoprotein-cholesterol, statins lead to significant risk reduction of cardiovascular and cerebrovascular diseases. Examples of statin medications include lovastatin, fluvastatin, pravastatin, atorvastatin, simvastatin and rosuvastatin. Statin-associated myopathy (SAM) represents a wide spectrum of clinical symptoms and signs, from asymptomatic increase of creatinine kinase serum activity to fatal rhabdomyolysis. Other symptoms may include muscular pain, tenderness, cramps or weakness. Patients with SAM usually improve rapidly once the medication that caused it is stopped. The diagnostic approach to patient with SAM is primarily based on the patient history, physical examination and laboratory tests.The treatment of SAM involves elimination of known risk factors, discontinuation of statin therapy and vitamin D and coenzym Q10 supplementations. Myopathy has been recognized as a side effect of glucocorticoid (corticosteroid) therapy. Development of the steroid-induced myopathy depends on the duration of the corticosteroid therapy, the dose and nature of the agent. Steroid-induced myopathy can occur in an acute or chronic form. The treatment of steroid-induced myopathy includes the reduction of steroid dose or discontinuation of steroid therapy.

• Keywords: toksična miopatija; statinima uzrokovana miopatija; steroidima uzrokovana miopatija
• Keywords (english): toxic myopathy; statin associated myopathy; steroid induced myopathy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:036029
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-08-22 07:57:50