BACKGROUND: The goal of the study was to assess the diagnostic and prognostic value of survivin in Juvenile Idiopathic Arthritis (JIA).
METHODS: Seventy children with JIA – 59 newly diagnosed and 11 biologically treated (46 girls and 17 boys) aged 1.5-18 years and 29 healthy children as a control group, appropriately matched in terms of sex and age, were included into the study. Concentration of survivin was assessed by an ELISA test in serum and also 18 matched synovial fluid samples collected from JIA patients.
RESULTS: Children with JIA were divided according to the subtype of the JIA. In 65.7% of patients oligoarthritis was diagnosed. The disease activity was established on the basis of JADAS-27 criteria, distinguishing three levels of inflammatory process activity: low, medium and high. The largest group comprised children of low activity (62.9%) of the disease. The serum concentration of survivin was significantly higher in JIA compared to the controls (p<0.001). Higher concentration of survivin correlated positively with the presence of anti-cyclic citrullinated peptide autoantibodies (ACPA) (p=0.001). In all synovial fluid samples the concentration of survivin was higher than in matched serum (p=0.003). Serum survivin concentration did not statistically significantly change according to radiological damage status or active synovitis assessed by joint ultrasonography. Survivin level was independent of the disease duration time and treatment with TNF-α inhibitors in DMARD’s non-responders.
CONCLUSIONS: On the basis of the conducted study, it could be concluded that survivin seem to be an independent biomarker that may be helpful in the diagnosis of JIA. Nevertheless, the higher concentration of survivin is being associated with ACPA positivity, survivin can act as a unique biomarker that identifies an additional group of patients with JIA negative for autoantibodies, even in the early stage of the disease. We have failed to confirm survivin prognostic potential for the active and destructive course of the rheumatoid process, however it is worth to underline that children have better potential for bone regeneration than adults. Survivin measurement should be considered as aiding tool identifying DMARD’s non-responders.