A double monoclonal immunoradiometric assay specific for bone alkaline
phosphatase (BAP) was used to determine whether the raised total alka
line phosphatase (TAP) often found in patients with active rheumatoid
arthritis (RA) and ankylosing spondylitis (AS) is derived from bone or
liver. Fifty-eight patients with RA were compared to 14 with AS and 1
4 with non-inflammatory rheumatic diseases (NI). None had clinical liv
er disease and only one had a slightly elevated aspartate transaminase
activity. Elevated BAP concentrations were found in seven patients (5
RA, 1 AS, 1 NI), only two of whom also had abnormal TAP. Abnormal TAP
activities were found in only three patients (all RA). BAP did not co
rrelate with disease activity in RA or AS. In contrast, TAP correlated
with disease activity (assessed by plasma viscosity) in RA (P < 0.02)
and AS (P < 0.002) and gamma-glutamyl transferase (GGT) also correlat
ed with plasma viscosity in RA (P < 0.01). Both TAP and BAP were signi
ficantly correlated with GGT in RA (P < 0.001 and P < 0.02, respective
ly). These findings are discussed, together with possible reasons for
the conflicting nature of some of the observations.