Serum Survivin in Patients with Rheumatoid Arthritis

Survivin is a member of the apoptosis inhibiting proteins. Suppression of apoptosis has been suggested as a key mechanism supporting selection and accumulation of distinct lymphocytes subsets in chronically inflamed joint tissues. The study was based on measuring the level of survivin in the sera of 35 RA and 15 matched control subjects. Results: Serum survivin is statistically higher in patients than control subjects with a mean value of 335±119.3pg and 161±55.2pg respectively. Moreover, patients showing radiological evidence of osteopenia, cysts and erosions showed higher survivin values yet the differences were not significant. Patients were further subdivided into lower and higher survivin groups with cut off value of 325pg/ml. In patients with higher values, it was found that the mean grip strength and the length of morning stiffness, erythrocyte sedimentation rate (ESR), serum creatinine, platelet count and reduction of Hb were higher but the difference was insignificant. Patients with lower survivin values were younger and had shorter disease duration but the only unexpected results were the presence of statistically higher proportion of positive chest manifestations on chest X-ray and the presence of more swollen joints in those patients. Moreover, the mean serum survivin was positivity correlated to the length of morning stiffness and negatively correlated to the intensity of drug intake which showed only statistical difference with methotrexate. Regression analysis showed higher slope with disease modifying drugs than NSAIDs. Conclusions: The usefulness of survivin as a prognostic tool for the erosive outcome in RA is partly supported by the findings in this study, however the effect of drugs should be considered, it may be true in the cases taking no drugs, in our case the effect of DMARD seem to influence the relation pattern to a great extent.