what diseases cause high ck levels

Furthermore, when evaluating patients with severely elevated CK concentrations, clinicians should be aware that in the absence of symmetric proximal muscle weakness, interstitial lung disease, or features of an overlap or antisynthetase syndrome, an IIM is less likely to be the cause of the elevated CK. This may feel like a small pinch. A muscle biopsy that may include special stains for sarcolemmal proteins for muscular dystrophy and biochemical muscle enzyme analysis for metabolic myopathies is diagnostic in only 20% to 25% cases of asymptomatic elevated CK on average, with a variation between different series of 0% to 79%.7,21,2733. Causes What is elevated creatine kinase? Department of Neurology Prospective follow up over a mean of 7.2 years16 of 23 patients who had been evaluated for elevated CK levels found the magnitude of CK elevation was not significantly changed at follow up. 2002;249:305-311. Creatine kinase is often incorrectly referred to as creatinine kinase. Know that having a high level of creatine kinase doesnt necessarily mean you have a medical condition and need treatment. Benign prognosis in idiopathic hyper-CK-emia. The authors of this study concluded that long-term follow-up is probably unnecessary in individuals with a normal initial evaluation. To use the sharing features on this page, please enable JavaScript. Polymyositis and dermatomyositis (second of two parts). There were 39 patients diagnosed with an IIM that did not meet the Bohan and Peter or Griggs criteria. Contact a health care provider if you have questions about your health. This practice could be different in other medical centers. Several forms of myopathy have been described that cause only CK level elevation without accompanying muscle weakness.4 These include dystrophic muscle disorders (eg, dystrophinopathies [especially female carriers]) and various forms of limb girdle muscle dystrophies (LGMD) (eg, LGMD1C [caveolin-3], 2A [calpain], 2B [dysferlin], 2D [alpha-sarcoglycan], 2I [fukutin-related protein], and 2L [anoctamin 5]). The inflammatory myopathies are important to diagnose because of the need for close clinical surveillance due to increased malignancy risk with some and, in the case of polymyositis, the potential benefits of treatment with immunotherapy. The Vanderbilt Synthetic Derivative database used in this study is supported by institutional funding and by the Vanderbilt CTSA grant ULTR000445 from NCATS/NIH. Exceptionally High Creatine Kinase (CK) Levels in Multicausal and Cleveland Clinic is a non-profit academic medical center. What can cause an elevated creatine kinase? As discussed earlier, patients who had already been diagnosed with an IIM and later developed a CK level greater than 1,000 IU/L were included in the final analysis. These include: You may also need this test if you had a muscle injury or stroke. Your privacy is important to us. You may feel a little sting when the needle goes in or out. 5. Kashani A, Phillips CO, Foody JM, et al. Once your doctor has determined the underlying cause of your elevated creatine kinase, it is very important to carefully follow the recommended treatment plan in order to reduce the risk of potential complications including: Copyright 2023 Healthgrades Marketplace, LLC, Patent US Nos. Iaccarino L, Pegoraro E, Bello L, et al. In women with a serum CK less than three times the upper limit of normal who have a family history of Duchenne or Becker muscular dystrophy, DNA analysis of blood lymphocytes identifies 70% of carriers.4. What Are Some of the Causes of Elevated CK and CK-MB Levels? A healthcare provider called a phlebotomist usually performs blood draws, which include those for a creatine kinase (CK) blood test, but any healthcare provider who is trained in drawing blood can perform this task. We are committed to providing our audience with actionable content and tools to help them make the best decision when it comes to choosing a healthcare professional. What It Means When Your Creatine Kinase Is Low - MSN Choose any area of neurology to see curated news, articles, case reports, and more on that topic. 8600 Rockville Pike Advertising on our site helps support our mission. Always check the given reference range on your lab report test results. This study was supported in part by the National Institutes of Health (K23AR064768), the Vanderbilt Physician Scientist Award, and the Rheumatology Research Foundation through the Medical and Pediatric Resident Research Award and the Career Development Bridge Funding Award: K Bridge. Disorders generally considered to be a part of the clinical IIM spectrum are dermatomyositis (DM), polymyositis (PM), inclusion body myositis (IBM), overlap syndromes, and necrotizing myopathies. J Neurol. CKs job is to add a phosphate group, a group of natural chemicals, to creatine, a substance in your muscle cells that helps your muscles produce energy. Fernandez C, Maues de Paula A, Figarella-Branger D, et al. Available from: National Heart, Lung, and Blood Institute [Internet]. A study of 107 patients. The https:// ensures that you are connecting to the 6 There is also a small reduction in CK levels as people age. Having a higher level of CK in your blood means you've experienced or are currently experiencing muscle damage. The authors provide a systematic approach, including repeat testing after a period of rest, defining higher thresholds over which pursuing a diagnosis is worthwhile, and evaluating for a variety of nonneuromuscular causes. These criteria identified 192 patients for inclusion in the final analysis (Fig 1). Most adult dystrophies and metabolic myopathies have no available treatment and their course is often benign, particularly if they present only with asymptomatic elevated CK. 2003;42:186-188. Bethesda (MD): U.S. Department of Health and Human Services; Muscular Dystrophy: Hope Through Research; [updated 2019 May 7; cited 2019 Jun 12]; [about 3 screens]. Eur J Neurol. In the largest study of asymptomatic hyperCKemia, a retrospective review of 114 people with either asymptomatic or paucisymptomatic hyperCKemia,12 82% were male, mean age 33, and the mean CK level was 1,410 units per L. An EMG was done for 100 of the participants and had normal findings in 43, myopathic findings in 44, and abnormal, nonmyopathic findings in 13. Submission of this form is subject to Healthgrades, Help Millions of people find the right doctor and care they need, Get immediate care and visit with providers from the comfort of your home, or anywhere, Urgent care centers can be faster and cheaper for situations that are not life threatening, Doctors and patients discuss the latest medical treatments and health tips, Search prescription drugs for why theyre used, side effects and more, Back and Neck Surgery (Except Spinal Fusion), http://www.labtestsonline.org/understanding/analytes/ck/glance.html, http://www.nlm.nih.gov/medlineplus/ency/article/003503.htm, Pain that radiates to the jaw or down the arm, Sudden weakness or numbness on one side of the body, Confusion or loss of consciousness, even for a brief moment. The site is secure. Health Information: Creatine Kinase: Test Overview; [updated 2018 Jun 25; cited 2019 Jun 12]; [about 2 screens]. These categories were chosen based on published review articles on the differential diagnosis of IIM and severely elevated CK levels [4-9]. Of course, it's not easy to put your mind at ease when you hear that. Muscle Nerve. Elevated CK levels should I be worried??? - Patient Patients may also be classified according to myositis-specific or myositis-associated antibodies such as the antisynthetase antibodies [10]. Description Isolated hyperCKemia is a condition characterized by elevated levels of an enzyme called creatine kinase in the blood. If you have questions about your results, dont be afraid to talk to your healthcare provider. All Rights Reserved. The cells in your skeletal muscles, heart muscles or brain release creatine kinase into your blood when theyre damaged. Dermatomyositis - Symptoms, Causes, Treatments - Healthgrades The European Federation of Neurological Societies guidelines recommend biopsy for patients with asymptomatic elevated CK who also have any of the following: Abnormal (myopathic) findings on electromyography, CK more than three times the upper limit of normal. Definitions of elevated CK (hyperCKemia) differ in the literature; it is most simply defined as a persistent elevation in serum CK level, at least 2 standard deviations above the mean expected for a given population on at least 2 separate occasions. sharing sensitive information, make sure youre on a federal Hormonal disorders, including disorders of the. Diagnostic workup of asymptomatic creatine kinase elevation. In patients with dermatomyositis, peculiar skin lesions are observed. Creatine kinase (CK) is an enzyme that mainly exists in your heart and skeletal muscle, with small amounts in your brain. Careers, Unable to load your collection due to an error. Tardive dyskinesia can be challenging, but with the right neurologist, support system, and education, you can manage the symptoms and get back to your normal life. High Creatine Kinase Levels and Muscle Damage | livestrong If your CK levels increase or stay at a persistently high level, it may indicate that you have ongoing muscle damage or muscle degeneration. Health Encyclopedia: Creatine Kinase (Blood); [cited 2019 Jun 12]; [about 2 screens]. Policy. This patient had previously received a diagnosis of IIM at another facility and had been treated as such for this condition, however in this study the patient was classified in the other diagnoses category as he was found to have patchy muscle atrophy of unclear etiology and without any clear evidence of inflammatory muscle disease. The CK levels and my chronic muscle pains are the only thing leading her to suggest the possiblity of Muscular Dystrophy. Creatine kinase or creatine phosphokinase is an enzyme chiefly found in the brain, skeletal muscles, and heart. CK-BB: Elevated levels of this enzyme may signify damage to the brain. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation and COVID-19 information. Trauma accounted for 10 (5%) cases and myocardial injury accounted for 5 (3%) cases. When any of these tissues are damaged, they leak creatine kinase into your bloodstream. Myopathies associated with hypothyroidism: a review based upon 13 cases, Rhabdomyolysis associated with hyperthyroidism, Serum enzymes in disease of skeletal muscle, Asymptomatic hyper-CK-emia: an electrophysiologic and histopathologic study, Hyper-CK-emia as the sole manifestation of myotonic dystrophy type 2, Duchenne muscular dystrophy and idiopathic hyperCKemia in the same family, A Japanese child with asymptomatic elevation of serum creatine kinase shows PTRF-CAVIN mutation matching with congenital generalized lipodystrophy type 4, Mutation in the CAV3 gene causes partial caveolin-3 deficiency and hyperCKemia, Follow-up of a large population of asymptomatic/oligosymptomatic hyperckemic subjects, Diagnostic evaluation of clinically normal subjects with chronic hyperCKemia, Muscle biopsy in the evaluation of patients with modestly elevated creatine kinase levels, The role of muscle biopsy in investigating isolated muscle pain, Muscle biopsy and in vitro contracture test in subjects with idiopathic hyperCKemia, Retrospective study of a large population of patients with asymptomatic or minimally symptomatic raised serum creatine kinase levels, Asymptomatic or minimally symptomatic hyperCKemia: histopathologic correlates, Benign prognosis in idiopathic hyper-CK-emia, Single-fiber electromyography in hyperCKemia: the value of fiber density, Approaches to the membrane theory of Duchenne muscular dystrophy, Muscular Dystrophy Research: Advances and New Trends, Familial idiopathic hyper-CK-emia: an underrecognized condition, The simple lab test is sometimes more complex than we think, if we think about it at all, Atypical hyperplasia of the breast: Clinical cases and management strategies, Autoimmunity and postural orthostatic tachycardia syndrome: Implications in diagnosis and management, Deadly drug rashes: Early recognition and multidisciplinary care, NONNEUROMUSCULAR CAUSES NEED TO BE INVESTIGATED, NEUROMUSCULAR CAUSES ARE NOT ALWAYS WORTH PURSUING, MUSCLE BIOPSY, ELECTROMYOGRAPHY, AND NERVE CONDUCTION STUDIES, Cleveland Clinic Center for Continuing Education. neurological symptoms and disorders. There was one case of a patient with a pre-existing diagnosis of IIM who had a non-IIM etiology of a CK greater than 1,000 IU/L. Antinuclear antibodies of a titer greater than or equal to 1:40 were more common in IIM patients than non-IIM patients (54% versus 24%, p < 0.001), and anti-Jo-1 antibodies were only found in patients with IIM (11% versus 0%, p = 0.001). Available from: UW Health [Internet]. Malignant hyperthermia testing in patients with persistently increased serum creatine kinase levels. CK stands for creatine kinase, an enzyme that leaks out of damaged muscle. Elevated CK levels may indicate skeletal muscle, heart or brain damage or degeneration either chronic (long-term) or acute (short-term). Brewster LM, Mairuhu G, Sturk A, van Montfrans GA. Distribution of creatine kinase in the general population: implications for statin therapy. Patients with necrotizing myopathies often have even higher CK concentrations than patients with DM or PM, while patients with IBM typically have lower CK concentrations, usually no greater than 12 times the upper limit of normal. Youll sit in a chair, and a healthcare provider will check your arms for an easily accessible vein. Muscle involvement in endocrine disorders often presents with muscle weakness in addition to muscle enzyme abnormalities. To get more information, your provider may order tests to check the levels of specific CK enzymes: Other conditions that can cause higher than normal CK levels include: If you have questions about your results, talk to your health care provider. Serum CK levels are strongly affected by race, sex, and physical activity. Always consult a medical provider for diagnosis and treatment. 2006;66:1585-1587. Stroes ES, Thompson PD, Corsini A, et al. The publisher's final edited version of this article is available at, idiopathic inflammatory myopathies, creatine kinase, polymyositis, dermatomyositis, myositis, Idiopathic Inflammatory Myopathy: 105 (55%), Non-Idiopathic Inflammatory Myopathy: 87 (45%). Idiopathic elevated serum CK is sometimes familial. CK is a type of protein. Am J Clin Pathol. In people who undergo EMG and have either myopathic or nonspecific findings, the next step is muscle biopsy with biochemical analysis and routine staining as well as staining for major histocompatibility complex 1 (MHC-1), dystrophin, sarcoglycan, dysferlin, -dystroglycan, and Western blot for dystrophin, dysferlin, and calpain. These elevated levels usually occur soon after a heart attack, states Healthgrades. This study has some limitations. Therefore, we reviewed cases referred to rheumatology at our medical center with a CK greater than 1,000 IU/L with the purpose of better defining the differential diagnosis and clinical characteristics of these patients and to determine if any clinical or laboratory parameters could be used to distinguished patients with IIM from those who present with other conditions. Three of these patients were diagnosed with statin-induced myositis. The Troms Study, Distribution of creatine kinase in the general population: implications for statin therapy, European Federation of Neurological Societies, EFNS guidelines on the diagnostic approach to pauci- or asymptomatic hyperCKemia, Efficacy and tolerability of lovastatin in 459 African-Americans with hypercholesterolemia, Heterogeneity of serum creatine kinase activity among racial and gender groups of the population, Persistent hyperCKemia: fourteen patients studied in retrospect, Malignant hyperthermia testing in patients with persistently increased serum creatine kinase levels, A rare but important cause for a raised serum creatine kinase concentration: two case reports and a literature review, Diagnosis, prevention, and management of statin adverse effects and intolerance: Canadian Working Group Consensus update, Statin-induced myopathy: the two faces of Janus, Narrative review: statin-related myopathy, SLCO1B1 variants and statin-induced myopathya genomewide study, Detection of macro-creatine kinase and macroamylase by polyethylene glycol precipitation and ultrafiltration methods, Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. Find information and tools about neurological diseases to assist patients and caregivers. the contents by NLM or the National Institutes of Health. However, there are many other endocrinologic, neuropsychiatric, neuromuscular, metabolic, and rheumatologic etiologies that must be considered when CK concentrations are severely elevated [4-9]. Thank you for your interest in spreading the word on Cleveland Clinic Journal of Medicine. This condition is sometimes referred to as asymptomatic hyper-CK-emia. Four other muscle enzymes that may also be elevated are aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and aldolase. If you have higher than normal CK-BB enzymes, it may mean you have had a stroke or brain injury. Hilton-Jones D. Myositis mimics: how to recognize them. An official website of the United States government. Referral to a rheumatology specialist is preferred. Most cases of raised creatine kinase can be attributed to normal variants or the acute effects of exercise, especially if associated with dehydration. . Neuromuscular disorders accounted for 4 (2%) cases. reported CK levels up to 12000 IU/l associated with macro CK, several of his patients were found to suffer from coexistent polymyositis. The authors provide a systematic approach, including repeat testing after a period of rest, defining higher thresholds over which pursuing a They will let you know if you need further testing. Cleveland Clinics Robert J. Tomsich Pathology & Laboratory Medicine Institute touches virtually every patient at Cleveland Clinic and thousands of patients across the world. treating problems of your brain, spinal cord and nerves, including these 8 Third Party materials included herein protected under copyright law. Retrospective study of a large population of patients with asymptomatic or minimally symptomatic raised serum creatine kinase levels. Br J Anaesth. Hypomyopathic dermatomyositis and inclusion body myositis can present with mild CK elevations with normal muscle strength, especially early in the disease course. Rarely, statin users develop a serious immune-mediated necrotizing myopathy.1113. For example, intense exercise can increase CK levels. It may result in chronic inflammation of your muscles and skin, which causes muscle pain, weakness, atrophy (reduction in size), and dysfunction. You may have slight tenderness or a bruise at the site of the blood draw, but this usually resolves quickly. That's when more medical detective work is needed. Our patients had CK levels of 1000-2000 IU/l that . When muscle is stressed or inflamed, the sarcoplasmic membrane becomes permeable and leaks cytosolic enzymes like creatine kinase into the bloodstream [1]. Metabolic myopathies reported to cause only hyperCKemia include disorders of carbohydrate metabolism (eg, myophosphorylase, -glucosidase, phosphofructokinase, and phosphorylase-b kinase deficiencies), lipid metabolism (eg, carnitine palmitoyltransferase type 2 deficiency), purine metabolism (myoadenylate deaminase deficiency), and mitochondrial cytopathies. Of the muscle biopses, 44 were abnormal, of which 20 were diagnostic. Prelle et al31 retrospectively reviewed the cases of 114 patients, ages 3 to 70, with incidentally discovered elevated CK and few or no symptoms, who underwent muscle biopsy, electromyography, and nerve conduction studies after nonneuromuscular causes were ruled out. Individuals with mild elevation in CK levels, who are taking these medications, likely need only periodic monitoring of CK values in the absence of symptoms or weakness on examination. Vrablik M, Zlatohlavek L, Stulc T, et al. Polymyositis and dermatomyositis (first of two parts), Bohan A, Peter JB. Creatine Kinase (CK): Unexpectedly High 2 Asymptomatic high CK: General More common in males than females May occur at all ages If high CK persists after rest: Evaluation usually includes EMG Muscle biopsy High CK with few, no, or atypical symptoms: Causes Endocrine Hypothyroid Hypoparathyroid Exercise 4 Acute Producing Muscle Hypertrophy Amir KA, Chen SX, Bobba RK, Arsura EL. Certain clinical features in these studies including younger age of onset and higher magnitude of CK elevation tended to predict whether a final diagnosis was made. The serum creatinine levels were lower in IIM patients than in non-IIM patients (0.69 mmol/L versus 1.17 mmol/L, p < 0.001). Muscle biopsy abnormalities are found in about two-thirds of cases of asymptomatic elevated CK, but most abnormalities include nonspecific myopathic changes that are not diagnostic. Blood test reports, including creatine kinase test reports, usually provide the following information: In a healthy adult, normal creatine kinase (CK) levels can vary due to a few factors, including your: Ranges also vary from lab to lab due to different test methods. Finally, there were 20 (10%) cases placed in the other diagnoses category that were unable to be classified elsewhere. CK-MB: Found mostly in your heart muscle. Until then, evaluation of asymptomatic or paucisymptomatic hyperCKemia will remain a frequent consultation for the practicing neuomuscular neurologist, and knowledge of the appropriate diagnostic evaluation is therefore practical and important. CK levels vary significantly by sex and race.5 Possible reasons include differences in muscle mass or total body mass and inherited differences in the permeability of the sarcolemma to CK.6 There is also a small reduction in CK levels as people age.2. They identified a single-nucleotide polymorphism in the SLCO1B1 gene on chromosome 12 that was strongly associated with a higher risk of statin-induced myopathy. Approach to asymptomatic creatine kinase elevation, PFN2 and GAMT as common molecular determinants of axonal Charcot-Marie-Tooth disease, CKing Precision in the Interpretation of Diagnostic Biomarkers, DOI: https://doi.org/10.3949/ccjm.83a.14120, Distribution of serum creatine kinase activity in young healthy persons, Variation of serum creatine kinase (CK) levels and prevalence of persistent hyperCKemia in a Norwegian normal population. The diagnosis of statin-associated myopathy was primarily based on the temporal relation of the onset and resolution of myositis with statin exposure and withdrawal, respectively. In conclusion, this study found that approximately half of patients referred to rheumatology with a CK greater than 1,000 IU/L were diagnosed with an IIM. The cells in your skeletal muscles, heart muscles or brain release creatine kinase into your blood when they're damaged. Adult onset polymyositis/dermatomyositis: an analysis of clinical and laboratory features and survival in 76 patients with a review of the literature. The relatively high proportion of nondiagnostic biopsies could be because of variability in skill of the interpreting physician, the quality of the specimens, limitations in testing performed on the specimens, or other factors. Some CK leaks from myocytes into the blood under normal physiologic conditions. Crushed, compressed, torn or strained muscles from accidents or intense exercise. Wong ET, Cobb C, Umehara MK, , et al. The SEARCH Collaborative Group14 conducted a genomewide association study of 300,000 markers in 85 patients with definite or incipient myopathy and in 90 controls, all of whom were taking simvastatin 80 mg daily. Cardiac causes should be evaluated by history and physical examination, electrocardiography, and possibly testing for cardiac troponins. There were 34 cases of IIM who had a pre-existing diagnosis of an IIM at the time of CK elevation greater than 1,000 IU/L. Experiencing muscle pain and weakness is usually temporary. CK levels may not peak until up to two days after certain injuries, so you may need to do the test more than once. Creatine Kinase - Kidneypedia Tests for Musculoskeletal Disorders; [updated 2017 Dec; cited 2019 Jun 12]; [about 2 screens]. CK levels vary significantly by sex and race. Before To our knowledge, no previous studies have reviewed the prevalence of IIMs in patients with markedly elevated CK concentrations who have been referred to rheumatology for consultation. If the MM isoenzyme is persistently elevated, the next step is to exclude nonneurologic causes by reviewing medications for drugs known to cause hyperCKemia and order lab tests to exclude systemic causes, including comprehensive metabolic profile, thyroid stimulating hormone and free thyroxine levels, parathyroid hormone level, and CK electrophoresis, the latter to evaluate for the presence of macroCK. High creatinine levels can indicate a range of underlying health conditions, including kidney infection and kidney failure. 13. 1983;79:582-586. How Are Low Creatine Kinase Levels Treated? URL of this page: https://medlineplus.gov/lab-tests/creatine-kinase/. Creatine kinase (CK) is an enzyme that mainly exists in your heart and skeletal muscle, with small amounts in your brain. Elevated enzymes can be a clue to a possible diagnosis of neuromuscular disease. The records were then reviewed for pertinent demographic data and clinical characteristics. HHS Vulnerability Disclosure, Help 2007;154:655-661. Taking this into account, a sensitivity analysis in which 35 cases of pre-existing IIM were removed from the cohort showed that the percentage of patients with CK elevations due to IIM would decrease to 45% and patients with non-IIM etiologies would increase to 55%. Follow-up of a large population of asymptomatic/oligosymptomatic hyperckemic subjects. Inclusion in an NLM database does not imply endorsement of, or agreement with, Elevated creatine kinase may accompany other symptoms of a heart attack including: Elevated creatine kinase may accompany symptoms that are related to other body systems including: An elevated creatine kinase can signal a heart attack or other serious condition. Creatine kinase or creatine phosphokinase is an enzyme chiefly found in the brain, skeletal muscles, and heart. This test measures the amount of an enzyme called creatine kinase (CK) in your blood. Statin-associated muscle symptoms have an estimated incidence of 1% to 5% in most randomized clinical trials [18, 19]. National Library of Medicine The remaining IIM patients were clinically diagnosed by the consulting rheumatologist with PM (n=3, 2%), a necrotizing myopathy (n=2, 1%), or an unspecified IIM (n=6, 3%). If youre experiencing prolonged muscle issues, talk to your healthcare provider about your symptoms. Rowland et al35 first coined the term idiopathic hyper-CK-emia and defined it as persistent elevation of serum CK despite a normal neurologic examination and testing, including electromyography, nerve conduction studies, and muscle biopsy.35,36 To receive this diagnosis, patients must also have no family history or clinical evidence of neuromuscular disease. Other blood tests, such as an electrolyte panel and kidney function tests, may be ordered along with a CK test. This test can help show if you have damage to your heart or other muscles. The MM form of CK is the type found in skeletal muscles, and it can be specifically measured . DAdda et al26 followed 55 people with idiopathic elevated CK for 7 years. Both the total CK level and the levels of isoenzyme fractions are needed to confirm that MM isoenzyme from muscle is elevated. MacroCK type 1 is a CKIgG antibody complex, most often associated with autoimmune disorders and with a prevalence in the general population of about 1%. This feature was present in 76 (72%) IIM patients and only 10 (11%) non-IIM patients. The number of patients meeting Bohan and Peter criteria for PM was 41 (21%), with 11 (6%), 18 (9%), and 12 (6%) patients meeting criteria for definite PM, probable PM, and possible PM, respectively. Patients with DM or PM often have high CK concentrations, usually more than 10-fold and sometimes up to 50-fold the upper limit of normal values [10]. It should also be noted that 13 of the IIM patients had a history of prior exposure to statins. Muscle Nerve. Approaches to the membrane theory of Duchenne muscular dystrophy. Assessment of patients with idiopathic inflammatory myopathies and isolated creatin-kinase elevation. All of these were muscular dystrophies with two cases of fascioscapulohumeral dystrophy and two cases of x-linked recessive muscular dystrophy. Junior Broncos Videos, List To String[], Articles W