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Serum glutamic oxalacetic transaminase in rheumatoid arthritis and certain rheumatoid musculoskeletal disorders.

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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.
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