Rheumatologist extraordinaire Mike George was kind enough to help us through a case of a middle-aged woman with weakness who was ultimately diagnosed with a necrotizing myopathy due to HMG CoA reductase antibodies. Along the way we learned how to approach a patient with weakness:

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Take home pearls:

  1. Use a neuroanatomic approach to a patient with weakness
  2. Perform a good neuro exam (including reflexes) on any patient with weakness
  3. Endocrine and toxic/drug myopathies are the most common of any kind of myopathy (including inflammatory myopathies)


  1. Chawla J. Stepwise Approach to Myopathy in Systemic Disease. Frontiers in Neurology 2011.
  2. Mammen, A. 2016. Statin-Associated Autoimmune Myopathy. The New England Journal of Medicine. 374, 7 (2016), 664–669.