In AFCAPS/TexCAPS, the number of participants with consecutive elevations of either alanine aminotransferase (ALT) or aspartate aminotransferase (AST) (> 3 times the upper limit of normal), over a median of years of follow-up, was not significantly different between the Lovastatin and placebo groups (18 [%] vs. 11 [%]). The starting dose of Lovastatin was 20 mg/day; 50% of the Lovastatin treated participants were titrated to 40 mg/day at Week 18. Of the 18 participants on Lovastatin with consecutive elevations of either ALT or AST, 11 (%) elevations occurred in participants taking 20 mg/day, while 7 (%) elevations occurred in participants titrated to 40 mg/day. Elevated transaminases resulted in discontinuation of 6 (%) participants from therapy in the Lovastatin group (n=3,304) and 4 (%) in the placebo group (n=3,301).
Because of the numerous causes associated with jaw pain and trismus ( SEE BOX )., additional diagnostics are warranted before initiating immunosuppressive therapy for masticatory muscle myositis. Other procedures that may aid in diagnosing masticatory muscle myositis include radiology and advanced imaging, electrodiagnostics, and histologic evaluation of biopsy specimens. Skull radiographs or computed tomograms should be obtained while patients are under general anesthesia. One classic finding in masticatory muscle myositis is inability to open the jaw while the patient is under anesthesia. Other abnormalities, such as fusion of the temporomandibular joints or healed fractures, may result in similar findings but should be eliminated from the differential diagnosis by conducting imaging studies.
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