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Elevated CK levels. Atrophy and fibrosis noted in muscle biopsy, no lipid storage disease. Suggestion?

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Practicing since : 1999
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Hi, I am active duty Air Force and I had consistently elevated CK levels and had a muscle biopsy and do not know what to make of the results and we don't have a doctor on base that can give a definitve answer. The first available Rhumo appointment here in Alaska is in 6 month. Here are the results of the biopsy.
Pathologic evaluation demonstrated no perifascicular atrophy or small group atrophy. There was
some nonselected atrophy at both slow and fast fibers with the suggestion of myofibertype
grouping without degeneration or regeneration. Mild endomysia! fibrosis was noted as well. No inclusions were seen on Gomori stain. There was no inflammatory reaction noted at any place nor was there perivascular alkaline phosphatase staining. There was no expression of histocompatibility type-1 antigens or lgG4. There was no evidence of a lipid storage disease. Myophosphorylase and phosphoritic kinase as well as AMP deaminase activities were present. They thought that the microscopic features were best dassified as degeneration atrophy with the suggestion for clinical correlation. Can you shed some light on the biopsy?
Posted Fri, 25 Jan 2013 in Lupus
Answered by Dr. Divya Agarwal 3 hours later

I have gone through all your reports and off course the muscle biopsy with diligence. The following are my comments:

1. It seems like the elevation of CPK was related to the use of statins and as I gather you have already stopped them.

2. To be very XXXXXXX none of your symptomology is co relating with the elevated CPK, although the CPK is raised and that is explained by the biopsy.

3. The reassuring part is that there is no inflammation in the muscle and not much of degeneration too.

4. Though muscle biopsy was performed to rule out inflammatory myopathy, it is reassuring to know the findings are not consistent and hence rules out inflammatory myopathy. I feel if it is a part of statin myopathy and it should gradually become better.

5. Your other symptoms are compatible with fibromyalgia and we should actually be concentrating on treating it with medicines and exercise. Since you are already on pregabalin for the same, other medicines like duloxetine and milnacipran may also be given for the same. Discuss with your treating doctor.

Hope I have addressed your concerns. Let me know if you have other concerns.

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