Niveles de survivina y su utilidad clínica en la artritis reumatoide/artritis idiopática juvenil: revisión sistemática de la literatura y meta-análisis
Thesis
Background: Rheumatoid arthritis (RA) is an autoimmune disease characterized by progressive joint damage that limits patients' quality of life and working years, generating high costs for healthcare systems. Its pathophysiology is still completely unknown; however, studies have been conducted in search of new biomarkers for its diagnosis. Survivin is apparently involved in the pathophysiology of the disease and is a potential biomarker in this condition. Objectives: To integrate the evidence on the role of the Survivin protein and its association with RA and Juvenile Idiopathic Arthritis (JIA), through a systematic review of the literature. Search methods: Searches were conducted in the following databases until April 2023: PubMed, EMBASE, and CINAHL. Selection criteria: Were included all analytical observational studies and clinical trials including patients with RA or JIA versus controls, evaluating the presence of Survivin in serum, plasma, or synovial fluid detected by ELISA or qPCR. Data collection and analysis: Two researchers independently reviewed and assessed the literature for inclusion and risk of bias, extracted data and checked their accuracy, and constructed the database with the included variables. For Survivin positivity, the OR was estimated using a random effects model, and for quantitative values we used the standardized mean difference (SMD). Main results: The meta-analysis included seven studies, five studies included case-control studies (n: 3 for RA, and n: 2 JIA) and two were cross-sectional studies (RA). RA/JIA patients had higher serum Survivin positivity compared to controls (913/1738 [52.5%] vs. 245/2010 [12.1%]) with an OR (13.89 [95% CI, 1.74-110.89]). SMD analysis confirmed that RA/JIA patients have higher levels of Survivin compared to controls (SMD = 2.05 [95% CI, 0.55-3.56]). Regarding synovial fluid, studies demonstrated elevated levels of Survivin in synovial fluid in JIA and RA patients compared to controls, as measured by ELISA, immunohistochemistry, among others. Likewise, different studies have reported a correlation between elevated levels of Survivin and both smoking and positivity of autoantibodies (RF and ACPAs). Conclusions: Survivin is a potential biomarker for the diagnosis of RA/JIA. Studies evaluating the suitability of this arthritis-specific biomarker is suitable, as well as its importance in disease activity and prognosis, are needed.
