Amanda Chang, MD, third-year internal medicine resident, and her mentor, Manish Suneja, MD, clinical professor in Nephrology and residency program director, shared a “teachable moment” that became so much more with its publication in the Journal of the American Medical Association (JAMA) Internal Medicine. While working together in inpatient Internal Medicine services, the pair encountered a patient who presented with statin-induced necrotizing autoimmune myopathy (SINAM), which they soon realized had been incorrectly diagnosed as treatment-resistant polymyositis. Though it occurs in just 1 in 100,000 patients taking a statin, SINAM can be life-threatening if not recognized and adequately treated.
Suneja said he encouraged Chang to take the leap of recording the initial case study, and served as an advisor and editor of the manuscript. He pointed out that because of JAMA IM’s high impact factor of 23.3, one of the highest of any internal medicine journal, and its low submission acceptance rate, Chang’s publication is an impressive accomplishment. After developing multiple drafts, incorporating comments by reviewers, and emphasizing the practical clinical impact of the study’s discussion, Chang and Suneja were “amazed and honored” to have their work accepted.
“It was a privilege to mentor Dr. Chang through the development of this publication, from shaping the early drafts to navigating the submission process. Her work highlights the importance of clinical vigilance in recognizing rare but reversible conditions such as statin-induced necrotizing autoimmune myopathy,” Suneja commented. “Her publication serves as a powerful reminder for internists everywhere to consider uncommon yet critical diagnoses in their daily practice.”
This reminder dovetails with JAMA’s mission to “examine innovative and feasible approaches to improve health care outcomes and quality at the level of the patient, health care professional, or health system,” and allowed Chang to examine her aspirations for her career after residency.
After graduation, Chang will enter the role of Ambulatory Chief Resident—a position newly created this year—and hopes to use the case featured in “Polymyositis Masking Statin-Induced Necrotizing Autoimmune Myopathy—A Teachable Moment” as the name implies.
“My goal is to improve the quality of our outpatient educational curriculum by having more standardized/structured educational lectures. I also hope to instill a passion—or at least an increased appreciation—for primary care amongst our IM residents, since preventative medicine often serves as the first step for improving the health and wellbeing of our patients.”
As such, Chang and Suneja believe in the importance of highlighting this rare condition to increase awareness and remind health professionals to think outside the box in providing quality care. With one teachable moment under her belt, and many more to come, Chang hopes internists, researchers, and others can gain important insight from this publication.
“Although rare, please be cognizant of SINAM as a potentially reversible cause of a profound, potentially debilitating weakness in patients on a statin,” Chang said. “For researchers, publishing your work can be a long journey, and it’s important to incorporate feedback. Keep being persistent throughout the publication process!”