Reduced Activity of Serum Creatine Kinase in Rheumatoid Arthritis: A Phenomenon Linked to the Inflammatory Response

Sanmartí, Raimón; Collado, Antonio; Gratacós, Jordi; Bedini, José Luis; Pañella, Daniel Raventós; Filella, Xavier; Llena, J. F.; Múñoz-Gómez, J

doi:10.1093/rheumatology/33.3.231

Cited by 23 publications

(21 citation statements)

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“…[12]. This might also be the case of our patient with an active symmetrical but non-erosive arthritis, although to our knowledge this finding has not yet been reported in polymyositis.…”

supporting

confidence: 64%

The Effect of Methylprednisolone Pulse Therapy in Polymyositis/Dermatomyositis

1999

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54The study aim was to assess the effect of corticosteroid (CS) therapy on the clinical and biological features of dermatomyositis (DM) or polymyositis (PM). Material and Methods7 adult patients with severe or refractory DM/PM diagnosed according to Bohan and Peter criteria, who also had involvement of bulbar muscles, respiratory insufficiency, myocardial involvement and/or total loss of ambulatory capacity, were included in study. The pulse-therapy consisted into daily pulses of 0.5 g methylprednisolone, 3 consecutive days/month, for three months. The following parameters were recorded upon presentation, and at one and three months of therapy respectively: muscle strength on a 6-steps scale, presence and type of cutaneous involvement, creatinkinase (CK) and C-reactive protein (CRP) levels.

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“…[12]. This might also be the case of our patient with an active symmetrical but non-erosive arthritis, although to our knowledge this finding has not yet been reported in polymyositis.…”

supporting

confidence: 64%

The Effect of Methylprednisolone Pulse Therapy in Polymyositis/Dermatomyositis

1999

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“…These facts make it questionable that GPI plays the same important role in human RA than it does in the K/BxN mouse model. The facts that RA patients have lower serum levels of CK-M and muscle weakness is sometimes reported make it appear worthwhile to examine the relevance of CK-M for the pathogenesis and diagnostic of RA [84]. Another aspect of antigen specificity being widely discussed is the finding of high reaction specificity against citrullinated peptides in the serum of RA patients.…”

Section: Ubiquitous Autoantigensmentioning

confidence: 99%

Morphological and molecular pathology of the B cell response in synovitis of rheumatoid arthritis

et al. 2002

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The synovitis of rheumatoid arthritis (RA) was long regarded merely as an unspecific chronic inflammatory process of minor diagnostic value and therefore did not play a major role in the understanding of the pathogenesis of RA. It is only in recent years, along with the observation that T and B cells are expanded oligoclonally in synovial tissue and that B cells are able to undergo a local germinal center (GC) reaction, that the synovial tissue has come to be regarded as a site of specific immune processes. The analysis of the immunoglobulin (Ig) gene repertoire had great impact on the understanding of B cell response in lymphatic organs and was subsequently applied to B cells from RA patients. The analyses of the variable (V) regions of the Ig heavy (H) and light (lambda) chains suggested that an antigen specific activation and differentiation of B cells into plasma cells (Plc) takes place in the chronically inflamed synovial tissue of patients with RA. It seems that in a subset of RA patients the synovial tissue develops into an ectopic lymphoid tissue that supports a local GC reaction. Ectopic GC are characteristic of RA; however, they are in general absent from synovitis of osteoarthritis (OA). Here the accumulation of Plc follows a different mechanism. Highly mutated VH genes suggest that in OA memory B cells migrate into the synovial tissue with subsequent differentiation into Plc but without further V gene diversification. Therefore in synovitis two patterns of B cell activation can be differentiated: the maturative and the accumulative type. These two patterns are not definitely disease linked. The maturative type is only found in RA whereas the accumulative type occurs in both diseases. Clinically RA is defined via serum antibodies to the constant region of Ig, so-called rheumatoid factor. However, the spectrum of autoreactive B cells in RA patients is wide and is based on the study of antibody specificities in serum, in synovial fluid and B cell lines derived from peripheral blood, bone marrow, synovial fluid and synovial tissue. These analyses defined non-organ-specific and organ-specific antigens. One can reasonably assume that the disease is far too complex to be explained by only a single antigen. There is a whole combination of antigens acting in a multistep manner that is responsible for RA pathogenesis. It can be hypothesized that chronic synovitis, which is the underlying mechanism of joint destruction, follows a three-step process: (a) initiation, (b) destruction, and (c) perpetuation. The characterization of antigens driving the local synovial B cell maturation and accumulation could lead to an understanding of the process perpetuating the disease. Identification of arthritogenic antigens may yield new avenues for diagnostics and immunotherapy but also a new approach for prevention by vaccines with antigens probably defined by synovial B cell reactivity.

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“…Several studies have shown that CK activity is reduced in a number of conditions, including inflammatory rheumatic diseases [3][4][5][6]. Recently, Sanmarti et al [4] showed an inverse correlation between CK activity and inflammatory activity in inflammatory rheumatic diseases.…”

Section: Introductionmentioning

confidence: 99%

Serum Creatine Kinase in Patients with Rheumatic Diseases

Lee

Choi

et al. 2000

Clinical Rheumatology

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Serum creatine kinase (CK) activity is reduced in some conditions, including rheumatic diseases, but the aetiology and significance remain to be clarified. The aim of this study was to investigate relationships between serum CK activity and other muscle enzymes, muscle mass, renal function, steroid use and disease activity in patients with rheumatic diseases. Serum CK activity was measured in sera from 498 patients with rheumatic diseases: rheumatoid arthritis (RA, n = 145), systemic lupus erythematosus (SLE, n = 31), spondyloarthropathies (SpA, n = 35), polyarthralgia/arthritis (Poly, n = 74), miscellaneous group (MI, n = 46), and in non-inflammatory arthropathies (NIA, n = 167) as controls. Serum CK level was significantly reduced in RA (45.4 +/- 1.9 IU/l), SLE (46.4 +/- 4.2 IU/l), SpA (64.7 +/- 5.6 IU/l) and MI (63.4 +/- 4.8 IU/l), but not in poly (70.2 +/- 3.1 IU/l), compared to controls (78.9 +/- 2.4 IU/l) (P < 0.05). CK values correlated with aspartate aminotransferase (AST), erythrocyte sedimentation rate (ESR), body mass index (BMI) and platelets (Plat) in RA; ESR and haemoglobin (Hb) in SLE, AST, ESR and Hb in SpA; lactate dehydrogenase (LDH), AST, ESR and Hb in Poly; LDH, AST, ESR, Hb and Ccr in MI; and LDH, AST and ESR in controls. In all patients with rheumatic diseases CK level was significantly correlated with LDH, AST, alanine aminotransferase (ALT), ESR, C-reactive protein (CRP) and BMI and prednisolone dose, but not with Ccr, age and disease duration. In conclusion, our data support the possibility that reduced CK activity is inversely correlated with inflammatory activity and correlated with other muscle enzymes, muscle mass and steroid use, but not with renal function, age and disease duration in rheumatic diseases.

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Reduced Activity of Serum Creatine Kinase in Rheumatoid Arthritis: A Phenomenon Linked to the Inflammatory Response

Cited by 23 publications

References 0 publications

The Effect of Methylprednisolone Pulse Therapy in Polymyositis/Dermatomyositis

The Effect of Methylprednisolone Pulse Therapy in Polymyositis/Dermatomyositis

Morphological and molecular pathology of the B cell response in synovitis of rheumatoid arthritis

Serum Creatine Kinase in Patients with Rheumatic Diseases

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