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Arthritis Res Ther. 2012; 14(3): R152.
Published online Jun 22, 2012. doi:  10.1186/ar3888
PMCID: PMC3446538
Aldolase predicts subsequent myopathy occurrence in systemic sclerosis
Cécile Tolédano,1 Murielle Gain,1 Adrien Kettaneh,1 Bruno Baudin,2 Catherine Johanet,3 Patrick Chérin,1 Sébastien Rivière,1 Jean Cabane,1 and Kiet Phong Tievcorresponding author1
1University Paris VI, AP-HP, Saint Antoine Hospital, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France
2Department of Internal Medicine, Biochemistry Laboratory, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France
3Immunology Laboratory, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France
corresponding authorCorresponding author.
Cécile Tolédano: cecile.toledano/at/sat.aphp.fr; Murielle Gain: murielle.gain/at/sat.aphp.fr; Adrien Kettaneh: adrien.kettaneh/at/sat.aphp.fr; Bruno Baudin: bruno.baudin/at/sat.aphp.fr; Catherine Johanet: catherine.johanet/at/sat.aphp.fr; Patrick Chérin: patrick.cherin/at/psl.aphp.fr; Sébastien Rivière: sebastien.riviere/at/sat.aphp.fr; Jean Cabane: jean.cabane/at/sat.aphp.fr; Kiet Phong Tiev: kiet.tiev/at/sat.aphp.fr
Received February 13, 2012; Revised May 12, 2012; Accepted June 22, 2012.
Abstract
Introduction
Myopathy related to systemic sclerosis (Myo-SSc) is a disabling and unpredictable complication of SSc. We assessed the predictive value of serum aldolase, creatine kinase (CK), alanine transaminase (ALT), aspartate transaminase (AST) and C-reactive protein (CRP) to estimate the risk of developing Myo-SSc.
Methods
We enrolled 137 SSc patients without proximal muscle weakness in a prospective monocentric study to follow them longitudinally over a four-year period. The risk of occurrence of Myo-SSc was ascertained according to the European NeuroMuscular Centre criteria and was analyzed according to levels of plasma aldolase, CK, transaminase enzymes and CRP at inclusion. Performance of each parameter to predict Myo-SSc occurrence was assessed and compared with the others.
Results
The area under the receiver operating characteristic curves (ROC) of plasma aldolase for Myo-SSc occurrence prediction was 0.80 (95% CI: 0.67 to 0.94, P < 0.001), which was higher than that of plasma CK (0.75, P = 0.01), and that of ALT (0.63, P = 0.04). AST and CRP had no predictive value for Myo-SSc occurrence. The best cut-off of aldolase for prediction of Myo-SSc occurrence within three years after inclusion was 9 U/L and higher than the upper normality limit (7 U/L), unlike that of CK and ALT. Myo-SSc occurred more frequently in patients whose plasma aldolase was higher than 9 U/L. Adjusted Hazard Ratio for patients with aldolase > 9 U/L was 10.3 (95% CI: 2.3 to 45.5), P < 0.001.
Conclusions
Increased plasma aldolase level accurately identified SSc patients with high risk to develop subsequent Myo-SSc. This could help initiate appropriate treatment when the disabling muscle damage is still in a reversible stage.
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