RT Journal Article SR Electronic T1 Autoimmune necrotising myopathy and HMGCR antibodies JF Practical Neurology JO Pract Neurol FD BMJ Publishing Group Ltd SP 151 OP 155 DO 10.1136/practneurol-2017-001848 VO 18 IS 2 A1 Kushan Karunaratne A1 Dimitri Amiras A1 Matthew C Pickering A1 Monika Hofer A1 Stuart Viegas YR 2018 UL http://pn.bmj.com/content/18/2/151.abstract AB Statins lower serum cholesterol concentrations by inhibiting the enzyme 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR). Muscle side effects are relatively common and include asymptomatic elevation of serum creatine kinase (CK), myalgia, proximal muscle weakness and rhabdomyolysis. More recently, a subset of cases of immune-mediated necrotising myopathy has been found to have antibodies against HMGCR. It is often an aggressive and debilitating myopathy and has a complex pathogenesis characterised by fibre necrosis, usually with minimal associated inflammation. Not all such patients are taking statins. The general consensus is that best treatment involves withdrawing the statin and giving immunosuppressive and immunomodulatory treatment. We describe three cases of HMGCR-related immune-mediated necrotising myopathy, detailing their clinical course and subsequent management, illustrating the spectrum of this disorder.