Simvastatin-induced erythromelalgia: less is more

[helvella]

This forum, Thyroid UK, is particularly aware of statins and their contra-indications. Furthermore, the whole cholesterol orthodoxy is questioned regularly.

This case report is (rightly) explicitly critical of the handling of the woman and her diagnosis of erythromelalgia - rather, failure to diagnose - and her inappropriate treatment. Mind, don't look for "thyroid" as the word does not occur, at least in the accessible abstract. My posting of it here is as another statin issue.

Erythromelalgia is a disorder with several aetiologies - including genetics - not all of which are known and appreciated. The prime symptoms are severe pain of the extremities, feet, hands and face are common but almost anywhere is possible, together with redness.

Acta Clin Belg. 2019 Jul 10:1-2. doi: 10.1080/17843286.2019.1640929. [Epub ahead of print]

Simvastatin-induced erythromelalgia: less is more.

Vanwonterghem Y1, Shadid S1.

Author information

1 a University Hospital Ghent , Department of Endocrinology , Belgium.

Abstract

We describe a case of a woman with uncomplicated Type 2 diabetes mellitus, presenting with severe burning pains and intense redness of the legs, for which only cooling could provide relief. Although the description was classic of erythromelalgia, the lack of familiarity of the disorder caused considerable doctor's delay as well as the erroneous advice to start pain killers and amitriptyline. However, empirical discontinuation of simvastatin made all symptoms disappear. Erthyromelalgia is a rare but debilitating disease which is diagnosed by exclusion only. It usually occurs as a secondary feature to (hematologic) malignant disorders, autoimmune diseases or, infections or, most notoriously, to pharmacological agents. One of the latter might be simvastatin, and possibly all HMG CoA Reductase inhibitors.

KEYWORDS:

Erthyromelalgia; HMG CoA Reductase inhibitors; adverse drug reaction; side effects; simvastatin; statins

PMID: 31291834

DOI: 10.1080/17843286.2019.1640929

ncbi.nlm.nih.gov/pubmed/312...

The Erythromelalgia Association set up a forum here on HU - then abandoned it before it even got going. There is a very slow trickle of posts.

healthunlocked.com/erythrom...

[Hidden]

"It usually occurs as a secondary feature to (hematologic) malignant disorders, autoimmune diseases or, infections or, most notoriously, to pharmacological agents"

Hmm, autoimmune diseases. Could be...

And I am so very glad I gave up statins

[SmallBlueThing]

They might get more hits without* the typo in their keywords.

* My tired noggin produced "withought", at first attempt.

[helvella Administrator in reply to SmallBlueThing]

Fully agreed. However, ironically, the MeSH system is quite powerful at finding and effectively correcting such things if you search within PubMed (or the rest of the associated sites). Have not yet checked...