Serum glutamic oxalacetic transaminase in rheumatoid arthritis and certain rheumatoid musculoskeletal disorders.код для вставкиСкачать
Serum Glutamic Oxalacetic Transaminase in Rheumatoid Arthritis and Certain Rheumatoid Musculoskeletal Diaorders By JAMES H. BARR,JR., BERTRAND L. STOLZER, CARLH. EISENBELS, JR., JOHN E. KURTZAND H. M. MARCOLE Serum glutamic oxalacetic transaminase levels were determined and compared in rheumatoid and nonrheumatoid subjects. The results indicate that tests for this enzyme would be of little value in establishing the presence or absence of rheumatoid disease. Le nivellos de transaminase glutamicoxalacetic in le sems de subjectos rheumatoide e non-rheumatoide esseva determinate e comparate. Le resultatos indica que tests pro iste enzyma esseren de pauc valor establir le presentin o le absentia de morbo rheumatoide. G LUTAMIC oxalacetic transaminase, an enzyme found in all body tissue except bone, is present in highest concentration in skeletal muscle, heart muscle, brain and liver tissue.l Serum concentrations of this enzyme have been reported to be elevated in some patients with dermatomyositis, acute rheumatic fever, toxemias of pregnancy, experimental tissue injury and bodily trauma.133*4Of special interest to us were the reported elevations noted after muscle injury and myocardial damage. Because of the atrophy and inflammatory changes in skeletal muscle tissue observed in rheumatoid arthritis, the question arose as to whether any correlation might be established between the degree of such muscle changes and the level of serum glutamic oxalacetic transaminase activity. Accordingly, a study was undertaken to determine the level of glutamic oxalacetic transaminase activity in sera from a group of patients with rheumatoid arthritis and from a control group of patients with certain nonrheumatoid musculoskeletal disorders. MATERTAL AND METHODS The serum transaminase levels were determined according to the method of Reitman and Frankel? By this method the aniount of oxalacetate formed after one hour incubation at 37” C. of serum with a standardized aspartate-glutarate (pH 7.5) substrate was measwed by the formation of a hydrazone compound. The resulting color change was read in a photoelectric colorimeter set at 505 mp. Calibration curves were formed with oxalacetic acid. Sera from normal individuals were run by this method in order to establish normal limits. These values fell in the range of 8 to 40 serum glatamic oxalacetic transaminase units. Serum transaminase levels and erythrocyte sedimentation rates were determined on one hundred patients seen on an out-patient basis. There were fifty-four patients with rheumatoid arthritis and forty-six with nonrheumatoid disorders. Of the latter, sixteen patients suffered from nonrheumatoid “fibromyositis”; twelve had degenerative joint disease; fivc, From the Department of Medicine, School of Medicine, University of Pittsburgh, a d the Oliver Research Lnhoratories of Saint Margaret Memorial Hospital, Pittsburgh, Penna. Thfs study was aMed by a grant from the Mary P . Burchfield Estate to the Western Pennsyluanh Chapter of the Arthritis and Rheumutkm Foundation. W e acknowledge with appreciation the technical assistance of Walter Leskowitz, B.S. 147 148 BARH, STOLZEH, EISENBEIS, JR., KURTZ AND MAHGOLIS gouty arthritis (none in an acute attack); five, subacroinial bursitis; and eight patients were in a miscellaneous group composed of Paget's disease, arteriosclerotic peripheral vascular disease and renal disease. Erythrocyte sedimentation rates were determined by the Cutler method, which involved using 13 mm. diameter tubes of 100 min. length nnd recording the level of erythrocyte sedimentation after thirty and sixty minutes. RESULTS With a single exception, the serum glutamic oxalacetic transaminase levels were normal in both groups of patients; namely, those with rheumatoid arthritis and those with nonrheumatoid disorders. The exception was a fiftytwo year old man with congestive heart failure, piilmonary fibrosis and emphysema, and degenerative joint disease, The data were further analyzed in an effort to determine if, within the range of normalcy, a correlation existed between the degree of musculoskeletal involvement, the erythrocyte sedimentation rate, and the level of the serum glutamic oxalacetic transaminase. Table 1 compares the serum glutamic oxalacetic transaminase level and erythrocyte sedimentation rates in fifty-four patients with rheumatoid arthritis and forty-six patients with nonrheumatoid musculoskeletal disorders. The average serum glutamic oxalacetic transaminase level was 15 units in the rheumatoid arthritics and 17 units in the nonrheumatoid group. Thus, there appears to be little difference between the groups regarding the average serum Slutamic oxalacetic transaminase levels. In addition, approximately the same percentage of patients in each group had serum glutamic oxalacetic transaminase titers greater than 20 and greater than 40. The erythrocyte sedimentation rate at the end of one hour averaged 19 mm. in patients with rheumatoid arthritis as compared with 12 mm. in the nonrheumatoid group, and, in addition, in the rheumatoid group 48 per cent had sedimentation rates greater than 20 mm. us compared with 10 per cent in the nonrheumatoid group. In the rheumatoid arthritic group, then, the average erythrocyte sedimentation rate and the percentage of patients with an erythrocyte sedimentation rate greater than 20 were higher than in the nonrheumatoid group. Table 2 is a detailed comparison of rheumatoid activity with the average serum glutamic oxalacetic transaminase titers and the level of the erythrocyte sedimentation rate. The grade of rheumatoid activity, determined by clinical evaluation, was listed as I to IV in increasing order of severity. The grade of rheumatoid activity in seven patients was found to be I; in thirtyTABLE1 Serum Gtutamic Ozalacetic Transaminam Activity Elythrocyte Sed. Rate ( 6 0 Minutes) Per Cent Patients Per Cent Patients with Level No. of Patients ~~ AveTfoe Units Greater than Greater than 2OUnits 40Units Average (mm.) with Rate Greater than 20 mm. ~ Rheumatoid Arthritis Nonrheunatoid 54 46 15 17 11% 17% 070 2% 19 12 48 qu 10% ` TABLE 2 SGO-T No. of Elythsowte Sed. Rate (60 Minutes) (Unite.) Per Cent Greater Than 20 mm. Grade Rhnunwto,'d d c t i u i t y Patients Average Average I I1 10 15 14 17 19 21 28% 44 Y O 111 7 32 14 IV 1 34 22 100% 64% two it was Grade 11; in fourteen, Grade 111; and in one, Grade IV. There was little or no variation in the average serum glutamic oxalacetic transaminase titers among the first three grades of rheumatoid activity. In the erythrocyte sedimentation rate, however, there was a stepwise variation from Grade I activity through Grade IV. It is obvious, then, that there was little difference in the serum glutamic oxalacetic transaminase level among the three stages of rheumatoid activity in which there was sufficient patient representation, but that a correlation existed between the erythrocyte sedimentation rate and the clinical estimation of severity of rheumatoid activity. Thirty-nine of the fifty-four patients were receiving prednisone or prednisolone in a dosage ranging from 7.5 to 15 mg. per day. In the fifteen patients who did not receive such steroid therapy, the average serum glutamic oxalacetic transaminase titer was 14. The rather even distribution of these fifteen patients throughout the first three grades of activity suggests that steroid therapy did not influence the average serum glutamic oxalacetic transaminase titer in those patients. There was little variation in the average serum glutamic oxalacetic transaminase titer among patients with fibromyositis, degenerative joint disease, gouty arthritis and bursitis. SUMMARY 1. The serum glutamic oxalacetic transaminase activity was determined in fifty-four patients with rheumatoid arthritis and in forty-six patients with nonrheumatoid disorders. There was no significant difference in the serum glutamic oxalacetic transaminase titers between the two groups. 2. With one exception the serum oxalacetic transaminase titer was not elevated in any of the hundred patients studied. It did not vary with activity of the rheumatoid state or the diagnostic category in the nonrheumatoid group. A correlation did exist between the erythrocyte sedimentation rate and the estimated degree of clinical activity of the rheumatoid state. 3. In view of these data, serum glutamic oxalacetic transaminase titers cannot be employed in the differential diagnosis of the various types of musculoskeletal disorders studied (that is, rheumatoid arthritis, degenerative joint ilisease, fibromyositis, gouty arthritis and bursitis), nor can the level of the serum glutamic transaminase titer be employed as an index of severity of rheumatoid activity. 4. It would appear likely that the established usefulness of the serum 150 BARR, STOLZEX, EISENBEIS, JR.,KURTZ AND MARGOLIS glutamic oxalacetic transaminase titer as n diagnostic aid in liver and myocardial disease may not be influenced by coexisting rheumatoid arthritis or such nonrheumatoid musculoskeletal disorders as were studied here. REFERENCES concentrations of the enzyme, glutamic 1. Mason, J. H. and Wroblewski, F.: Serum oxalacetic transaminase. Circulation 12: glutamic oxalacetic transaminase activ795-806, 1955. ity in experimental and disease states. Int' Med. 99:245-252' 4. Lieherman, J., Lasky, I. I., Dulkin, S. I. 1957. and Lobskin, 0. E.: Serum glutamic 2. Chinsky, M., Shmagranoff, G. L. and oxalacetic transaminase activity in conSherry, S.: Serum transaminase activditions associated with myocardial inity: Observations in a large group of farction. 1. Bodily trauma. Annals Int. patients. J. Lab. & Clin. Med. 47~10% Med. 46:485-496, 1957. 118, 1956. 3. Nzdick, I., Tang, J., Stollerman, G. H., 5. Reitman, S. and Frankel, S.: Colorimetric method for the determination of serum Wroblewski, F. and LaDue, J. S.: The transaminase activity, to be published. influence of rheumatic fever on serum James H . Barr, Jr., A.B., M.D., Clinical Zns-tructor in Medicine, School of Medicine, University of Pittsburgh; Associate Visiting Physician, St. Margaret Memorial and Montefiore Hospitals, Pittsburgh, Pa. Bertrand L. Stoker, B.S., M.D., Clinical Instructor in Me& cine, School of Medicine, University of Pittsburgh; Associate Visiting Physician, St. Margaret Memorial Hospital; Senior Assistant Visiting Physician, Montefiore Hospital, Pittsburgh, Pa. Carl H . Eisenbeis, Jr., B.S., M.D., Clinical Znstructor in Medicine, School of Medicine, University of Pittsburgh; Assistant Visiting Physician, St. Margaret Memorial Hospital; Senior Assistant Visiting Physician, Montefiare Hospital, Pittsburgh, Pa. John E . Kurtz, B.S., M.D., Clinical Assistant Professor of Pathology, School of Medicine, University of Pittsburgh; Pathologist, St. Margarot Memorid Hospital, Pittsburgh, Pa. H. M. Margolis, B.A., M.D., iM.S., Assistant Professor of Medicine, School of Medicine, University of Pittsburgh; Chief of the Arthritis Clinic, Falk Clinic, University of Pittsburgh; Senior Visiting Physician, St. Margaret Memorial and Montefiore Hospitals, Pittsburgh, Pa.