Approach to a patient with elevated serum creatine kinase
Authors:
H. Mann
Authors place of work:
Revmatologický ústav a Klinika revmatologie 1. LF UK, Praha
Published in the journal:
Čes. Revmatol., 30, 2022, No. 2, p. 67-73.
Category:
Review Article
Summary
Mann H. Approach to a patient with elevated serum creatine kinase
Physicians frequently encounter patients with elevated serum creatine kinase (CK) levels in clinical practice without objective signs of muscle disease. The standard laboratory reference range does not reflect serum CK distribution in the population. Moreover, physical activity can lead to a marked CK elevation; therefore, abnormal results are frequently reported in otherwise healthy subjects. Primary myopathies are rare; other causes, including metabolic disorders, endocrinopathies, and adverse drug reactions, should always be excluded first in patients with persistent CK elevation. Muscle biopsy does not always clarify a diagnosis and should only be performed in selected cases. In recent years, modern genetic methods, referred to as next-generation sequencing, have played a role in diagnosing subclinical myopathies. This paper aims to acquaint the reader with the issues involved in interpreting serum CK results, introduce the differential diagnosis of elevated values, and provide basic guidance on how to proceed in searching for a cause.
Keywords:
statins – creatine kinase – idiopathic hyperCKemia – myopathy
Zdroje
- Okinaka S, Sugita H, Momoi H, et al. Serum creatine phosphokinase and aldolase activity in neuromuscular disorders. Trans Am Neurol Assoc 1959; 84: 62–64.
- Kyriakides T, Angelini C, Schaefer J, et al. EFNS guidelines on the diagnostic approach to pauci- or asymptomatic hyperCKemia. Eur J Neurol 2010; 17: 767–773. 73 PŘEHLEDOVÝ ČLÁNEK
- Silvestri NJ, Wolfe GI. Asymptomatic/pauci-symptomatic creatine kinase elevations (hyperckemia). Muscle Nerve 2013; 47: 805–815.
- Sargsyan Z. Importance of Aminotransferase Elevation in Detecting Myopathy. Am J Med 2018; 131: e483.
- Katiriji B, Al Jaberi MM. Creatine kinase revisited. J Clin Neuromuscul Dis 2001; 2: 158–164.
- Saenger AK, Jaffe AS. Requiem for a heavyweight: the demise of creatine kinase-MB. Circulation 2008; 118: 2200–2206.
- Schmid J, Liesinger L, Birner-Gruenberger R, et al. Elevated Cardiac Troponin T in Patients With Skeletal Myopathies. J Am Coll Cardiol 2018; 71: 1540–1549.
- Brewster LM, Mairuhu G, Sturk A, van Montfrans GA. Distribution of creatine kinase in the general population: implications for statin therapy. Am Heart J 2007; 154: 655–661.
- Lilleng H, Abeler K, Johnsen SH, et al. Variation of serum creatine kinase (CK) levels and prevalence of persistent hyperCKemia in a Norwegian normal population. The Tromsø Study. Neuromuscul Disord 2011; 21: 494–500.
- Kodatsch I, Finsterer J, Stöllberger C. Serum creatine kinase elevation in a medical department. Acta Med Austriaca 2001; 28: 11–15.
- Borgatta B, Pérez M, Rello J, et al. Elevation of creatine kinase is associated with worse outcomes in 2009 pH1N1 influenza A infection. Intensive Care Med 2012; 38: 1152–1161.
- Orsucci D, Trezzi M, Anichini R, et al. Increased Creatine Kinase May Predict A Worse COVID-19 Outcome. J Clin Med 2021; 10: 1734.
- Narayanappa G, Nandeesh BN. Infective myositis. Brain Pathol 2021; 31: e12950.
- Pasnoor M, Barohn RJ, Dimachkie MM. Toxic myopathies. Neurol Clin 2014; 32: 647–670.
- Joy TR, Hegele RA. Narrative review: statin-related myopathy. Ann Intern Med 2009; 150: 858–868.
- Pella D, Gvozdjáková A, Lietava J, et al. Myopatie asociovaná se statiny: klinické doporučení Slovenskej asociácie aterosklerózy a České společnosti pro aterosklerózu. AtheroRev 2016; 1: 7– 13.
- Mammen AL. Statin-Associated Autoimmune Myopathy. N Engl J Med 2016; 374: 664–669.
- Tiniakou E, Rivera E, Mammen AL, Christopher-Stine L. Use of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors in Statin-Associated Immune-Mediated Necrotizing Myopathy: A Case Series. Arthritis Rheumatol 2019; 71: 1723–1726.
- Galarraga B, Sinclair D, Fahie-Wilson MN, et al. A rare but important cause for a raised serum creatine kinase concentration: two case reports and a literature review. Rheumatology (Oxford) 2003; 42: 186–188.
- Ambler Z, Bednařík J. Myopatie – základní charakteristika, klasifikace a perspektivy. Neurologie pro praxi 2004; 5: 135–136.
- Lundberg IE, Fujimoto M, Vencovsky J, et al. Idiopathic inflammatory myopathies. Nat Rev Dis Primers 2021; 7: 86.
- Shibata M, Kasahara H, Makioka K, et al. Neurogenic calf amyotrophy with CK elevation by entrapment radiculopathy; clinical, radiological, and pathological analyses of 18 cases. J Neurol 2020; 267: 3528–3540.
- Hosokawa T, Nakajima H, Sawai T, et al. Clinical features of Guillain-Barré syndrome patients with elevated serum creatine kinase levels. BMC Neurol 2020; 20: 214.
- Finsterer J, Aliyev R. Chronic Inflammatory Demyelinating Polyneuropathy Variant with Creatine-Kinase Elevation and Vanishing Effect of Immunoglobulins. Am J Case Rep 2017; 18: 834–838.
- Chahin N, Sorenson EJ. Serum creatine kinase levels in spinobulbar muscular atrophy and amyotrophic lateral sclerosis. Muscle Nerve 2009; 40: 126–129.
- Moghadam-Kia S, Oddis CV, Aggarwal R. Approach to asymptomatic creatine kinase elevation. Cleve Clin J Med 2016; 83: 37–42.
- Silvestri NJ, Wolfe GI. HyperCKemia. Pract Neurol 2019; 19: 38–41.
- Walters J, Baborie A. Muscle biopsy: what and why and when? Pract Neurol 2020; 20: 385–395.
- Zámečník J. Svalová biopsie v deseti bodech. Cesk Slov Neurol N 2018; 81: 358–361.
- Shaibani A, Jabari D, Jabbour M, et al. Diagnostic outcome of muscle biopsy. Muscle Nerve 2015; 51: 662–668.
- Tomasová Studynková J, Charvát F, Jarosová K, Vencovsky J. The role of MRI in the assessment of polymyositis and dermatomyositis. Rheumatology (Oxford) 2007; 46: 1174–1179.
- Fernandez C, de Paula AM, Figarella-Branger D, et al. Diagnostic evaluation of clinically normal subjects with chronic hyperCKemia. Neurology 2006; 66: 1585–1587.
- Gemelli C, Traverso M, Trevisan L, et al. An integrated approach to the evaluation of patients with asymptomatic or minimally symptomatic hyperCKemia. Muscle Nerve 2022; 65: 96–104.
- Nigro V, Savarese M. Next-generation sequencing approaches for the diagnosis of skeletal muscle disorders. Curr Opin Neurol 2016; 29: 621–627.
- Rowland LPWJ, Cerri C, DiMauro S, Miranda A. Approaches to the membrane theory of (uchenne muscular dystrophy. In: Angelini C, Danielli GA, Fontanari D. (eds.) Muscular Dystrophy Research: Advances and New Trends, Amsterdam. Excerpta Med 1980; 3–13.
- Capasso M, de Angelis MV, di Muzio A, et al. Familial idiopathic hyper-CK-emia: an underrecognized condition. Muscle Nerve 2006; 33: 760–765.
- D’Adda E, Sciacco M, Fruguglietti ME, et al. Follow-up of a large population of asymptomatic/oligosymptomatic hyperckemic subjects. J Neurol 2006; 253: 1399–1403.
- Wu L, Brady L, Shoffner J, Tarnopolsky MA. Next-Generation Sequencing to Diagnose Muscular Dystrophy, Rhabdomyolysis, and HyperCKemia. Can J Neurol Sci 2018; 45: 262–268.
- Savarese M, di Fruscio G, Torella A, et al. The genetic basis of undiagnosed muscular dystrophies and myopathies: Results from 504 patients. Neurology 2016; 87: 71–76.
Štítky
Dermatology & STDs Paediatric rheumatology RheumatologyČlánok vyšiel v časopise
Czech Rheumatology
2022 Číslo 2
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