No abstract

BackgroundRheumatoid arthritis (RA) is a progressive debilitating autoimmune disease leading to cartilage and bone destruction caused by insufficient apoptosis in the inflamed RA synovium. Survivin is a proto-oncogene biomarker known for its anti-apoptotic and cell cycle regulating properties and has been linked linked to inflammation, presumably contributing to the decreased apoptosis in the T cells in non cancerous proesses.ObjectivesThe aim of this study is to measure the serum and synovial levels of survivin and clarify their relations to disease activity, functional capacity and radiographic damage in RA patients.MethodsThis study was carried out on 50 RA patients (F:M=39:11) had a mean age of (46.4±10.94) years and 30 subjects of matched age and sex with a mean age of (46.03±10.53) years and F:M (23/7) as a control group. All patients were subjected to full history taking, thorough clinical examination, assessment of disease activity by DAS-28 score and functional capacity and using Health assessment Questionnaire (HAQ). Plain x- ray radiographs of both hands and feet were done, scored and graded by Larsen score. Survivin levels in all studied subjects′ sera and the synovial fluid aspirated from 18 RA patients presented with knee effusion at the time of examination were measured by enzyme- linked immunosorbent assay (ELISA).ResultsThe mean serum survivin level was highly significantly elevated (p<0.001) in the RA patients sera than in the controls’ being 479.61±52.68 (pg/ml) and 239.1±115.15(pg/ml) respectively. Synovial survivin levels ranged between 420–575 (pg/ml) with a mean of 479.61±52.68 (pg/ml) and was significantly higher than in the RA patients′ sera (p<0.001). RA patients were divided into survivin –ve group included 21/50 (42%) and survivin +ve group included 29/50 (58%), the serum survivin cut off point (167.63 pg/ml) was selected at the mean plus 3 SD for the control group. Survivin+ve RA patients group have significantly longer mean disease duration and higher HAQ and larsen scores (p<0.001) than survivin –ve RA patients group. 9/13 (69%) of the RA patients with Sjogrene’s syndrome, 8/10 (80%)of the patients with pleural effusion, 3/6 (50%) patients with Raynaud’s phenomenon, all patients with sc nodules (5, 100%), episcleritis (2,100%) and vasculitis (1,100%) were survivin +ve. RA patients who had Larsen score grading ≥2 (27/50, 52%) were considered to have an erosive RA disease. There were no statistically significant differences between RA patients according to the presence of erosion regarding age, sex, VAS, DAS score, the presence of RF abs, Anti- CCP abs, mean HB%, WBCs count, PLTs count, ESR 1 st hr value or CRP level.All RA patients with erosive disease were survivin +ve and had statistically significantly elevated mean serum and synovial survivin levels than the RA patients with non erosive disease (337.37±55.19 pg/ml vs 126.78±24.33 pg/ml and 422.5±3.53 pg/ml vs 486.75±51.52 pg/ml respectively)ConclusionsHigh levels of survivin are detected in the blood and synovial fluid of RA patie...