Open Access Open Badges Research article

Aldolase predicts subsequent myopathy occurrence in systemic sclerosis

Cécile Tolédano1, Murielle Gain1, Adrien Kettaneh1, Bruno Baudin2, Catherine Johanet3, Patrick Chérin1, Sébastien Rivière1, Jean Cabane1 and Kiet Phong Tiev1*

Author Affiliations

1 University Paris VI, AP-HP, Saint Antoine Hospital, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France

2 Department of Internal Medicine, Biochemistry Laboratory, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France

3 Immunology Laboratory, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France

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Arthritis Research & Therapy 2012, 14:R152  doi:10.1186/ar3888

Published: 22 June 2012



Myopathy related to systemic sclerosis (Myo-SSc) is a disabling and unpredictable complication of SSc. We assessed the predictive value of serum aldolase, creatine kinase (CK), alanine transaminase (ALT), aspartate transaminase (AST) and C-reactive protein (CRP) to estimate the risk of developing Myo-SSc.


We enrolled 137 SSc patients without proximal muscle weakness in a prospective monocentric study to follow them longitudinally over a four-year period. The risk of occurrence of Myo-SSc was ascertained according to the European NeuroMuscular Centre criteria and was analyzed according to levels of plasma aldolase, CK, transaminase enzymes and CRP at inclusion. Performance of each parameter to predict Myo-SSc occurrence was assessed and compared with the others.


The area under the receiver operating characteristic curves (ROC) of plasma aldolase for Myo-SSc occurrence prediction was 0.80 (95% CI: 0.67 to 0.94, P < 0.001), which was higher than that of plasma CK (0.75, P = 0.01), and that of ALT (0.63, P = 0.04). AST and CRP had no predictive value for Myo-SSc occurrence. The best cut-off of aldolase for prediction of Myo-SSc occurrence within three years after inclusion was 9 U/L and higher than the upper normality limit (7 U/L), unlike that of CK and ALT. Myo-SSc occurred more frequently in patients whose plasma aldolase was higher than 9 U/L. Adjusted Hazard Ratio for patients with aldolase > 9 U/L was 10.3 (95% CI: 2.3 to 45.5), P < 0.001.


Increased plasma aldolase level accurately identified SSc patients with high risk to develop subsequent Myo-SSc. This could help initiate appropriate treatment when the disabling muscle damage is still in a reversible stage.