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Serum Creatine Kinase and Aldolase as Screening Markers for the Detection of Antisynthetase Syndrome
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A1596 - Serum Creatine Kinase and Aldolase as Screening Markers for the Detection of Antisynthetase Syndrome
Author Block: S. Castillo, M. J. Hamblin, B. Forbes; Pulmonary and Critical Care, The University of Kansas Medical Center, Kansas City, KS, United States.
RATIONALE: The antisynthetase syndrome is characterized by the presence of anti amino acyl-transfer RNA (tRNA) antibodies associated with a wide variety of clinical manifestations, including myositis, interstitial lung disease (ILD), mechanic’s hands and polyarthritis. The muscle enzymes creatine kinase (CK) and aldolase are often elevated in patients with an antisynthetase syndrome indicative of the myositis associated with the disease. The purpose of this study was to evaluate the ability serum CK and aldolase to serve as screening labs to identify the presence of anti tRNA antibodies indicative of an antisynthetase syndrome in patients undergoing work up for ILD at a Tertiary Center.
METHODS: We reviewed the records of 90 patients in whom a Mayo Myositis Panel had been ordered as part of the workup for new diagnosis of ILD. Frequency tables were obtained for each of the antisynthetase antibodies. The proportion of patients with elevated serum aldolase and serum CK was calculated as well as other markers such as antinuclear antibody (ANA), ESR and CRP. Sensitivity and specificity for these markers in patients with at least one positive antisynthetase antibody were calculated. Statistical analysis was performed using SPSS version 22.
RESULTS: The mean age was 61 years (±13.1). 51.1% were males. At least one positive antisynthetase antibody was identified in 39 patients (43%). The three most commonly identified antisynthetase antibodies were anti-SSA (20.8%), anti-PM/SCL (9.5%) and anti-Jo1 (8.9%) antibodies. The sensitivity for identifying at least one positive antisynthetase antibody was 53.8% for aldolase, 39.5% for CK, 30.8% for ESR, 48.7% for CRP and 55.3% for ANA. The specificity was 43.1% for aldolase, 76% for CK, 62.5% for ESR, 58.7% for CRP and 56% for ANA. When either an elevated aldolase or elevated CK was evaluated, the sensitivity was 59% and the specificity was 39%. When both of these markers were elevated, the sensitivity was 33.3% but the specificity increased to 82.4%.
CONCLUSIONS: In our study the most commonly identified antisynthetase antibodies were the anti-SSA, anti-PM/SCL and anti-Jo1 (8.9%). The sensitivity for identifying at least one positive antisynthetase antibody was low for all markers studied, including CK and aldolase. However, the specificity was greater when both markers were within normal levels, which suggests that when positive, they could potentially be used to identify those patients who would benefit from having a Mayo Myositis Panel checked for further recognition of an Antisynthetase Syndrome. Further research is needed to evaluate this association.
Author Block: S. Castillo, M. J. Hamblin, B. Forbes; Pulmonary and Critical Care, The University of Kansas Medical Center, Kansas City, KS, United States.
RATIONALE: The antisynthetase syndrome is characterized by the presence of anti amino acyl-transfer RNA (tRNA) antibodies associated with a wide variety of clinical manifestations, including myositis, interstitial lung disease (ILD), mechanic’s hands and polyarthritis. The muscle enzymes creatine kinase (CK) and aldolase are often elevated in patients with an antisynthetase syndrome indicative of the myositis associated with the disease. The purpose of this study was to evaluate the ability serum CK and aldolase to serve as screening labs to identify the presence of anti tRNA antibodies indicative of an antisynthetase syndrome in patients undergoing work up for ILD at a Tertiary Center.
METHODS: We reviewed the records of 90 patients in whom a Mayo Myositis Panel had been ordered as part of the workup for new diagnosis of ILD. Frequency tables were obtained for each of the antisynthetase antibodies. The proportion of patients with elevated serum aldolase and serum CK was calculated as well as other markers such as antinuclear antibody (ANA), ESR and CRP. Sensitivity and specificity for these markers in patients with at least one positive antisynthetase antibody were calculated. Statistical analysis was performed using SPSS version 22.
RESULTS: The mean age was 61 years (±13.1). 51.1% were males. At least one positive antisynthetase antibody was identified in 39 patients (43%). The three most commonly identified antisynthetase antibodies were anti-SSA (20.8%), anti-PM/SCL (9.5%) and anti-Jo1 (8.9%) antibodies. The sensitivity for identifying at least one positive antisynthetase antibody was 53.8% for aldolase, 39.5% for CK, 30.8% for ESR, 48.7% for CRP and 55.3% for ANA. The specificity was 43.1% for aldolase, 76% for CK, 62.5% for ESR, 58.7% for CRP and 56% for ANA. When either an elevated aldolase or elevated CK was evaluated, the sensitivity was 59% and the specificity was 39%. When both of these markers were elevated, the sensitivity was 33.3% but the specificity increased to 82.4%.
CONCLUSIONS: In our study the most commonly identified antisynthetase antibodies were the anti-SSA, anti-PM/SCL and anti-Jo1 (8.9%). The sensitivity for identifying at least one positive antisynthetase antibody was low for all markers studied, including CK and aldolase. However, the specificity was greater when both markers were within normal levels, which suggests that when positive, they could potentially be used to identify those patients who would benefit from having a Mayo Myositis Panel checked for further recognition of an Antisynthetase Syndrome. Further research is needed to evaluate this association.
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