Rheumatology Question 36

A 61-year-old man is evaluated for a 10-month history of generalized weakness. He reports no pain or myalgia. History is significant for hypercholesterolemia treated with a stable dose of simvastatin for the past 3 years. On physical examination, temperature is normal, blood pressure is 138/74 mm Hg, pulse rate is 70/min, and respiration rate is 16/min. BMI is 27. There is symmetric weakness of the arm and thigh muscles with slightly reduced grip and power of the finger flexors. No muscle tenderness is noted. There is no rash, skin thickening, or digital ulcers. Reflexes and the remainder of the physical examination are normal. Laboratory studies are notable for a normal complete blood count, an erythrocyte sedimentation rate of 23 mm/h, and a serum creatine kinase level of 365 U/L. Chest radiograph is normal. Electromyogram and nerve conduction studies show myopathic changes in the proximal and distal muscles of the extremities as well as some neurogenic changes.

Which of the following is the most likely diagnosis?

A Amyotrophic lateral sclerosis

B Inclusion body myositis

C Myasthenia gravis

D Statin-induced myopathy

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