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Creatine Metabolism in Arthritis

1952; BMJ; Volume: 11; Issue: 1 Linguagem: Inglês

10.1136/ard.11.1.23

1468-2060

J. E. Dawson, H. B. Salt,

Muscle metabolism and nutrition

The results published by Granirer (1949) of his investigation of creatinuria in patients with rheumatoid arthritis and osteo-arthritis appeared especially interesting, as few such studies had previously been recorded.The extensive work of Wang (1939) on creatine metabolism included a study of only three arthritic patients.All of these were regarded as having significant creatinuria of varying degree, but this was attributed by Wang to the accompanying muscular atrophy.Pemberton and Buckman (1920) had earlier studied forty cases of arthritis in men,'with the conclusion that about one-half of these showed an abnormally high value for blood " creatine ", but that only three of the cases showed creatinuria.In the control series of nine normal men, no creatinuria was found.Granirer's results were obtained from adult male and female subjects and yielded the following mean values for the 24-hr urinary creatine excretion: 675 mg. for ten osteo-arthritics 185 mg. for ten elderly healthy controls 176 mg. for ten patients with rheumatoid arthritis 161 mg. for ten young healthy controls.These findings, together with a consideration of normal levels of creatinuria previously postulated by certain other workers, led Granirer to conclude that creatinuria is a normal process in the adult male and female; that patients with active rheumatoid arthritis have also a normal creatinuria; and that in patients with osteo-arthritis there exists the possibility of an abnormal excretion of creatine.It is well known that creatine is an integral factor in the activity of muscle and in the cycle of carbohydrate metabolism, although the amount of creatine excreted in the urine depends rather on a process of disposal of creatine present in excess of that required for metabolic needs.The nature and purpose of the process of disposal of the excess creatine are still obscure (Peters and Van Slyke, 1946), though it has been noted by various investigators (quoted by Boland, 1950) that a marked increase in creatinuria was found during the early phase of cortisone and ACTH administration, which increase may or may not continue during the period of treatment.Using an improved method (Peters, 1942) for the determination of creatine 23 copyright.