Serum Transaminases during Salicylate Therapy

Abstract

SummaryIn 8 out of 32 juvenile patients suffering from chronic polyarthritis and in one patient with dermatomyositis, raised transaminase levels were found; the salicylate level was above 35 mg/100 ml in all except one. Reduction in the salicylate level led to a prompt fall in the serum transaminases. Despite a rise in alkaline phosphatase in three cases there was no other evidence of liver dysfunction in the children. Only one of the adults showed a rise in transaminase levels, and she had mild cirrhosis. IntroductionOur attention was drawn to the association of increased levels of serum transaminases with high serum salicylate levels in a girl with juvenile chronic polyarthritis admitted routinely for establishment on a salicylate regimen. She complained of feeling unwell and was found to have mild hepatomegaly and raised transaminase levels; at this time her serum salicylate level had risen to 45 mg/100 ml. On stopping aspirin therapy the transaminase levels rapidly returned to normal and the hepatomegaly disappeared. In view of this 50 further patients were studied.

Salicylate hepatotoxicity in patients with juvenile rheumatoid arthritis

“…The present investigation suggests, to the contrary, that disturbances of liver function occur regularly in patients with JRA treated with salicylates in doses sufficient to raise serum levels above 25 mg/100 ml. These data confirm and extend the observations of Manso et aZ(5) that a majority of patients, with or without evidence of acute rheumatic fever, developed elevations of SGOT and SGPT 6 to 32 days after beginning a course of salicylates, and the report of Russell et a1 (6) of elevated serum transaminase levels in juvenile patients with chronic polyarthritis and high serum salicylate levels.…”

“…More than half of the patients studied, both patients with possible rheumatic fever and those without evidence of rheumatic disease, developed elevations of one or both enzymes. Recently Russell et al (6) reported transient elevations of serum transaminase levels in 8 of 32 juvenile patients suffering from chronic poly-arthritis and in 1 patient with dermatomyositis. These abnormalities were reversibly associated with salicylate therapy; the serum salicylate level was greater than 35 mg/100 ml in all cases except one.…”

Correlations between transaminase concentrations and serum salicylate concentration in juvenile rheumatoid arthritis

“…In one series of 32 children with JRA, elevated transaminase levels were found only with salicylate concentrations greater than 35 mg/dl (6). In another study of 6 adults and children with JRA, abnormal transaminase concentrations appeared only with salicylate concentrations greater than 25 mg/dl (7).…”

Salicylate‐induced hepatic injury

“…A recent article by Samaha and lrvin (3) in which native dsDNA was purified by means of methylated albumin Kieselguhr chromatography reports similar results. Our study and theirs support the premise that antidsDNA antibodies are specific for SLE and suggest that false positive tests can result from contamination of native dsDNA with dsDNA having ss regions.…”