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Muscle enzymes can be normal or elevated. High muscle enzymes in the blood can indicate that muscle cells have been damaged. This can be caused by muscle-wasting disorders or damage to another organ that contains the same enzymes as muscles, such as the liver. Doctors test muscle enzyme levels to screen for medical conditions that cause elevated muscle enzymes. Creatine kinase (CK) is an enzyme that is released by damaged muscles and can be used to diagnose and monitor muscle injuries and diseases. Other causes of elevated muscle enzymes include serious injuries, working in hot places, overusing muscles, certain medications, and viral infections.
| Characteristics | Values |
|---|---|
| Muscle enzymes | Creatine phosphokinase (CPK), aldolase, aspartate and alanine transaminases, lactate dehydrogenase |
| Causes of elevated muscle enzymes | Muscle injury, vigorous exercise, muscle-wasting disorders, damage to another organ with the same enzymes (e.g., liver), drug toxicities, viral infections, etc. |
| Diseases associated with elevated muscle enzymes | Myositis, inflammatory myopathy, necrotizing autoimmune myopathy, dermatomyositis, muscular dystrophy, myocarditis, lung tissue damage, rhabdomyolysis, etc. |
| Diagnostic tests | CK test, troponin test, MRI, EMG, biopsy, blood tests for autoantibodies, etc. |
| Treatment | Immunosuppression, immunomodulation |
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What You'll Learn
Muscle injury or strain
Creatine kinase (CK) is an enzyme found in skeletal muscles, heart muscles, and the brain. CK helps the body make energy, and usually, only a small amount of it gets into the blood. However, when the muscles, heart, or brain tissues are damaged, larger amounts of CK are released into the bloodstream. Therefore, elevated CK levels may indicate muscle injury or disease.
Muscle injuries or strains can occur when a muscle or tendon overstretches and is placed under more physical stress than it can withstand. This can happen during everyday tasks or sports activities. Strains commonly result in a partial or complete tear of a tendon or muscle, and they most often occur in the foot, leg, or back. The symptoms of a strain include pain, functional loss of the involved structure, muscle weakness, contusion, and localized inflammation.
The first-line treatment for a muscular strain in the acute phase includes five steps commonly known as P.R.I.C.E: Protection, Rest, Ice, Compression, and Elevation. A new treatment for acute strains is the use of platelet-rich plasma (PRP) injections, which have been shown to accelerate recovery from non-surgical muscular injuries.
In addition to CK, other muscle enzymes that are released by damaged muscles include creatine phosphokinase (CPK), aldolase, aspartate and alanine transaminases, and lactate dehydrogenase. Raised aspartate and alanine transaminases can cause diagnostic confusion with liver diseases. CPK is the most specific enzyme in polymyositis and dermatomyositis, although it can also be normal or minimally elevated in inclusion body myositis.
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Vigorous exercise
Elevated levels of CK in the blood can be a sign of muscle damage or disease. Intense exercise can cause a rapid breakdown of muscle tissue, known as rhabdomyolysis, which can lead to muscle weakness, stiffness, and changes in urine colour. Rhabdomyolysis is a rare but life-threatening condition that can occur after excessive exercise without rest, especially if the body is already dehydrated and overheated. It is more common in endurance athletes who push themselves too hard without adequate recovery.
In addition to CK, other muscle enzymes such as aldolase, aspartate and alanine transaminases, and lactate dehydrogenase can also be elevated after vigorous exercise. The intensity and duration of exercise play a role in the elevation of these enzymes, with untrained athletes experiencing larger and more prolonged increases compared to trained athletes. Resistance training and ultra-endurance events with significant elevation changes can also lead to significant muscle damage and elevated enzyme levels.
It is important to note that elevated muscle enzymes after vigorous exercise are usually temporary and do not necessarily indicate an underlying medical condition. However, if symptoms of muscle damage or degeneration persist, it is recommended to consult a healthcare provider for further evaluation and appropriate treatment.
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Autoimmune response
Myositis is an autoimmune disease characterised by inflammation of muscles. It can present in different forms, and people with lupus, scleroderma, or vasculitis may also have muscle inflammation as a secondary feature. Myositis can affect the whole body, not just the muscles.
Autoimmune inflammatory myopathies can be primary, occurring on their own, or secondary, occurring in patients with other rheumatic diseases such as scleroderma or vasculitis. The muscle inflammation in myositis is caused by white blood cells of the immune system, which are normally supposed to protect the body from infections. However, in people with myositis, these cells mistakenly attack a person's own healthy muscle fibres, injuring or destroying them. This affects muscle function and can lead to fatigue and weakness.
Myositis patients can experience muscle weakness, lung disease, arthritis, Raynaud's phenomenon, and "mechanic's hands", which is the thickening of the skin on the palms and fingers. Other tests, like anti-SRP and anti-HMGCR, are associated with necrotizing autoimmune myopathy (NAM), also known as immune-mediated necrotizing myopathy (IMNM). NAM symptoms tend to be limited to the muscle, and the levels of muscle enzymes in the blood are often very high. In approximately 15-20% of cases of dermatomyositis, and less often in other forms of myositis, myositis occurs in the context of cancer. For this reason, when any myositis patient is newly diagnosed, they should be screened for cancers. In that case, the dermatomyositis is believed to represent an attempt by the immune system to eliminate the cancer. However, because the cancer has some similar proteins to skin and muscle, that immune response causes injury to those other tissues as well.
Serum CK is elevated in 90% of dermatomyositis patients and can be as high as 50 times the upper limit of normal. However, serum CK levels can be normal, particularly early in the course of the disease. Antinuclear antibodies are present in 24-60% of patients but are much more common in patients with overlap syndromes. Jo-1 antibodies are more common in polymyositis than dermatomyositis and are associated with ILD. Anti-Mi-2 antibodies are seen almost exclusively in dermatomyositis, occurring in 15-25% of patients. Other myositis-specific antibodies are uncommon.
Serum aldolase levels are increased in many patients with active muscle damage. In some cases, autoimmune myopathy patients may present with elevated aldolase levels in the context of normal CK. However, serum aldolase elevations may not be as specific for active muscle damage as CK.
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Genetic factors
While elevated muscle enzymes can be caused by a variety of factors, genetic factors play a significant role in some cases. Here is a detailed discussion on the genetic factors that can lead to elevated muscle enzymes:
Genetic Mutations and Neuromuscular Disorders: Genetic mutations inside muscle cells can lead to neuromuscular disorders, such as muscular dystrophies. In these disorders, muscle tissue gradually degenerates due to the genetic mutation, resulting in elevated levels of enzymes like ALT, AST, and CK in the blood. This occurs because these enzymes leak out of damaged or degenerating muscles. For instance, Duchenne muscular dystrophy is a genetic condition that can lead to rhabdomyolysis, a rapid breakdown of muscle tissue, resulting in elevated muscle enzymes.
Metabolic Myopathies: Metabolic myopathies are another group of genetic disorders that can cause elevated muscle enzymes. These disorders are characterised by a deficiency of specific enzymes involved in energy production for muscle contraction. The affected muscles cannot function normally, leading to symptoms such as progressive muscle weakness, exercise intolerance, and even heart problems. Metabolic myopathies can be associated with elevated CK levels, indicating muscle damage or degeneration.
Genetic Susceptibility: Certain genetic variations can increase an individual's susceptibility to developing muscle-related conditions, such as statin-related myopathy. Patients with this condition have a higher frequency of occult metabolic muscle disease, suggesting a potential genetic predisposition. Genetic testing may be necessary to screen for underlying genetic conditions that increase the risk of muscle enzyme elevation.
McArdle Disease: McArdle disease is a rare genetic disorder that affects the body's ability to break down glycogen for energy, particularly in muscles. This condition can lead to elevated muscle enzyme levels, particularly CK, as the muscles struggle to produce enough energy, resulting in muscle damage or weakness.
While genetic factors can contribute to elevated muscle enzymes, it is important to note that not all cases of elevated muscle enzymes are due to genetic causes. Environmental factors, injuries, and other medical conditions can also play a role. A comprehensive evaluation by a healthcare professional is necessary to determine the specific cause of elevated muscle enzymes in an individual.
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Liver damage
Elevated liver enzymes may also be temporary and not indicative of liver damage. Intense physical exercise can cause a rise in liver enzymes due to muscle damage and repair. When muscles are damaged, enzymes such as AST and ALT are released, leading to increased concentrations in the blood. This is why athletes may commonly exhibit elevated liver enzymes.
It is important to note that GGT (Gamma-glutamyl transpeptidase) is a more specific indicator of liver health. Unlike AST and ALT, GGT is not found in muscle tissue, and elevated GGT levels are typically not linked to muscle damage from exercise. Factors such as alcohol consumption, certain medications, and an unhealthy lifestyle can cause GGT levels to rise.
If you suspect liver damage or have concerns about elevated liver enzymes, it is always advisable to consult a healthcare professional. They can perform liver function tests, blood tests, and imaging tests to evaluate your liver health and determine the underlying cause of any issues.
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Frequently asked questions
Your body's muscle tissue contains several enzymes, which are catalysts that cause chemical reactions. Your muscles require chemical reactions to supply them with energy, help them repair damage and help them function.
Muscle enzymes may be elevated due to muscle-wasting disorders, damage to an organ that contains some of the same enzymes as your muscles, or muscle injury. Muscle injuries can be caused by accidents, serious burns, extreme exercise, or working in very hot places.
Very high levels of muscle enzymes can indicate a large amount of muscle tissue damage, also called rhabdomyolysis, which is potentially life-threatening. Proteins from broken-down muscle tissue can collect in the kidneys and cause kidney damage or acute renal failure.
Doctors test muscle enzyme levels to screen for medical conditions that cause elevated muscle enzymes. Creatine kinase (CK) or creatine phosphokinase (CPK) tests are used to help diagnose and monitor muscle injuries and diseases that damage skeletal muscles and cause high levels of CK in the blood.
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