Thank you for your query at DoctorSpring.com.
I have read your question with diligence.
You have raised CPK and Serum Uric acid. These tests are marker of muscle dysfunction. When drawing a blood sample to test CPK levels, certain precautions should be taken. Otherwise, the values can be falsely raised. If the values are truly raised, then a diagnosis of Myositis (inflammation of muscles) etc. have to be considered and further evaluation needs to be done.
There are some other cause which can be responsible for his problem. Looking at your present details you should consult your physician and ask for a referral to a Rheumatologist. Till then you should keep yourself well hydrated and avoid excessive protein in your diet.
Hope this was helpful to you. Feel free to ask queries.
With best wishes.
Patient replied :
Thank you for your response. My CPK has been done twice while avoiding any form of exercise for a few days and both times the values have turned out to be high. You mention there could be other causes for this problem. Please elaborate as my query was not just regardig high CPK levels. What possible diagnosis comes to mind when you think of high CK along with high uric acid and diminished desnsity of calf muscles? Can Rhabdomyolysis be a possibility? Please advice.
Thank you for the follow up.
I understand your concern and i apologize for not being more elaborative in my last reply to you.
Let me give a detailed reply this time.
Firstly you have high CPK levels. To go into the causes it mostly indicates some kind of muscle weakness and disease such as polymyositis, or myositis, muscular dystrophy, or Rhabdomyolysis. In your case polymyositis may be a possibility, however there will be no muscle destruction, or shortening as in your case. Muscular dystrophy again mostly is manifested during childhood, however some cases can be delayed up to the 20s and it can be associated with other autoimmune conditions such as Type 1 DM in your case. This will need a thorough evaluation with a Rheumatologist, who can asses your muscle bulk and do some other tests to find out the extent of destruction.
Now coming to Rhabdomyolysis. It does not seem likely in your case, because most patients with Rhabdomyolysis present with progressive muscle weakness, also associated with a dark cola colored urine since there is increased destruction of muscle tissue and the excess myoglobin gets excreted in the urine. Suspecting that you were advised to keep yourself adequately hydrated, and avoid over exercising. Though it seems unlikely in absence of other factors, it is better to rule it out, since it can cause acute kidney injury, doe to toxic myoglobin. The Rheumatologist can order appropriate tests, but Serum Myoglobin is something that will make the picture clearer.
Regarding the uric acid levels, sometimes in patients with concurrent diabetes, uric acid levels can be high. It mostly points towards gout. This can be diagnosed if your uric acid levels are continuously high, and x ray of the knees, are suggestive of gouty arthritis. So i will suggest you also get a X Ray of both the knees and follow it up with your rheumatologist when you discuss about your case. I know you have been to several doctors and it can be very frustrating. In case you have already reviewed your x ray and there is nothing wrong with the joints, and there are no features of arthritis, then this uric acid level can be directly due to your diabetes. As i said it can be concurrent. In case you haven't then X Ray of the knees and the possibility of gout has to be discussed with the Rheumatologist.
I will suggest you get a Serum Myoglobin done and the X rays taken and then follow it up.
Hope this was helpful,