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Aldolase When CK Normal — SCE Rheumatology MCQ

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ModerateMyositisAldolase When CK NormalSCE Rheumatology

A 55-year-old woman has subacute symmetrical proximal muscle weakness, Gottron papules and muscle oedema on MRI. Her serum creatine kinase is repeatedly normal, and there is no evidence of haemolysis or liver disease. Her rheumatologist requests serum aldolase. Which statement best describes the role of this investigation?

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Correct answer: E — It is a useful adjunct because some inflammatory myopathies have raised aldolase despite normal CK.

Aldolase is a useful adjunct when inflammatory myopathy remains clinically likely despite a normal CK. Selective aldolase elevation has been described in biopsy-proven dermatomyositis, overlap myositis and myopathies with perimysial pathology. In this patient, objective proximal weakness, characteristic dermatomyositis skin signs and MRI muscle oedema make a normal CK insufficient to exclude active muscle disease. Aldolase is less muscle-specific than CK and should not replace CK, imaging, electrophysiology or biopsy where indicated. It is not primarily a test for separating hepatic from muscular AST elevation, and haemolysis can confound rather than define its usefulness. Isolated aldolase elevation is not specific to inclusion body myositis.

Reference: Soontrapa P, et al. Disease spectrum of myopathies with elevated aldolase and normal creatine kinase. European Journal of Neurology. 2024;31(2):e16117. https://pubmed.ncbi.nlm.nih.gov/37922500/