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- Page navigation anchor for When stopping statin is not enough in treating statin induced myopathy- a new treatable entity to considerWhen stopping statin is not enough in treating statin induced myopathy- a new treatable entity to considerWe discuss a 67 year old right handed gentleman who presented with a 3 month history of gradually progressive severe bilateral proximal arm and leg weakness following hip surgery. During his second presentation to A&E, neurology opinion was sought because of two falls, and inability to transfer and lift arms. His past medical history included type 2 diabetes mellitus, hypertension, dyslipidaemia, osteoarthritis and vitamin B12 deficiency. He was on atorvastatin 20 mg since 2003; the dose was increased to 80 mg in 2012. Examination revealed marked proximal upper and lower limb weakness (2 to 3/5) - lower limb weakness was more prominent. His creatinine kinase (CK) was markedly elevated at 6400 and electromyogram showed irritable proximal myopathy. Weakness and CK elevation persisted despite stopping statin treatment which he had been taking for fourteen years. Serology was positive for 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMCGR) antibody. Treatment with intravenous immunoglobulin, prednisolone and methotrexate led to remarkable improvement of weakness. In his last clinic follow up, he was independent in activities of daily living.Statin induced autoimmune myopathy (SIAM) is a rare clinical entity (incidence: 2 to 3/100000 patients treated) which presents with proximal weakness, very high CK and the presence of HMGCR antibody. SIAM should be suspected if CK is raised more than 10 times of the upper limit of normal and weaknes...Show MoreCompeting Interests: None declared.