Alkaline phosphatase

[Badgergirl]

I had my bloods done again last week. My ESR and CRP have returned to normal at 3 each following a massive flare. My spine is still sore and I still can't straighten up, however.

What concerns me is my ALP is very high at 280. My other liver enzymes are normal e.g.. ALT. I am being sent for a liver scan.

Has anyone else had experience of high ALP with PMR? I know it can be raised in GCA. What else could be causing it? My vitamin D levels are low. Also, I have been popping 8 paracetamol a day for a couple of months now.

Thanks in advance for any light shed on this. Badgergirl

[PMRpro Ambassador]

Another lady was told by her GP to use paracetamol for pain when osteoarthritis pain returned as her pred dose reduced. She was a bit unwilling but her GP assured her it was perfectly safe at the recommended dose. A couple of months later her liver enzymes were a bit dodgy. Cue panic on the part of the GP and he sent her for a liver scan. Which was perfectly normal. She stopped the paracetamol and the liver enzymes went back to normal.

Contrary to common opinion, paracetamol is NOT as innocent as they like to think.

Thirty years ago I had what was probably the 6-month herald illness of ME. My liver enzymes were awry and I was referred to hospital. In those days you waited 6 months for that whatever appeared to be wrong and by the time I got there they were back to normal and the intense fatigue (I couldn't stand for more than a few minutes) was improving. The consultant decided it had probably been a virus and there was no more to be done. In the early days of the bad PMR flare I also had raised alk phos but it went back to normal eventually - my liver scan was normal too despite a consultant being totally convinced I was an alcoholic (he ordered a banana bag as treatment for a transient global amnesia - had something to do with his country of origin I suspect but that's a whole other story).

You are having a really bad PMR/something allied episode - it may be associated.

[Badgergirl in reply to PMRpro]

Haha! My GP asked me if I had been drinking lots of alcohol too. I wish! Daren't touch it!

I don't think paracetamol are that innocent either. I haven't stopped them but have cut down to 4 a day. When the gabapentin start helping more maybe I can stop them. Or should I stop them now?

I did find it odd that the ALP raised all of a sudden and the ALT (alanine aminotransferase) was normal. So I did wonder if I might have physiological signs of GCA. I had pains in my jaw 3 nigjhts running before the blood test, which stopped when I went up to 30 mg.

This episode does seem to be going on and on. A spinal x ray was normal and I am now waiting for an MRI on my thoracic spine. According to a paper I read, PMR can cause intraspinal bursitis.

Thanks again PMRpro for timely reassurance. Perhaps my liver scan will be OK too.

[PMRpro Ambassador in reply to Badgergirl]

uptodate.com/contents/clini...

aafp.org/afp/2000/0815/p789...

link.springer.com/article/1...

Just 3 of a load of refs mentioning elevated alk phos in PMR and GCA. I'm simply flabbergasted at the lack of knowledge of common findings in PMR. And all they have to do is google "alk phos polymyalgia rheumatica" and they can see it without even reading the papers (I have, some I'd read before). They'd save their time, the technician's time and the cost to the NHS.

Bah!!!!

[Badgergirl]

That's an excellent paper. Very thorough. Interesting that it says the alkaline phosphatase can be raised in PMR but not the other liver enzymes.

I probably don't even need a scan!

[PMRpro Ambassador in reply to Badgergirl]

More than likely not! When I was sent for mine it was to an evening session to try to combat the waiting list (they cost the departments A BOMB). The radiographer called me in, did the scan and snorted as she said "Absolutely normal - as usual!" A brief conversation revealed that if you MENTIONED having a drink or produced a slightly elevated liver enzyme at that time (5 years ago) you were sent for a liver scan by many doctors - hence the waiting lists. There is a terrible reliance on the numbers instead of putting the brain in gear. And the rather born-again liver consultants who are seeing an increase in drink-related liver disease have scared the living daylights out of their juniors. In my case it was a gentleman from the Middle East who assumed we in the west are all going to hell in a handcart. My GP fell off his seat laughing at the idea of me being an alcoholic - I would very much like to see my hospital notes though.

[Badgergirl in reply to PMRpro]

Crazy. I used to measure ALT levels in my uni research and if someone had drank even one pint of beer before coming for their measurement it had shot right up. It was always normal next time