Background/Purpose: High levels of the oncoprotein survivin may be detected in the majority of patients with early rheumatoid arthritis (RA). Survivin is a sensitive predictor of joint damage and persistent disease activity. Survivin-positive patients are often poor responders to anti-rheumatic and biological treatment. Present study investigates the reproducibility of survivin status in paired samples from RA patients.

Methods: Survivin levels were measured in 339 patients from the BARFOT cohort of early RA at baseline and after 24 months. The association of survivin status with joint damage (total Sharp-vd Heide score), disease activity (DAS28), functional disability (HAQ), and pain perception (VAS) was calculated in the groups positive and negative for survivin on both occasions, and for the positive-negative and negative-positive groups.

Results: In 268 patients (79%) the levels of survivin were similar at baseline and after 24 months, 15% converted from survivin-positive to being negative, and 5% from survivin-negative to being positive. A combination of smoking and aCCP antibodies predicted high levels of survivin on both test occasions (OR4.5 [95%CI: 7.54-2.74], p<0.001, PPV 0.67 and specificity 0.84). Survivin positivity on both test occasions was associated with the progression of joint damage, significantly higher DAS28 and lower rate of remission at 24 and 60 months compared to negative-negative patients. Survivin status was less associated with changes in HAQ and VAS. 

Conclusion: Survivin status in RA patients may be predicted by smoking and aCCP and is highly reproducible at 24 months follow-up. Survivin is a relevant marker to use in predictive models and on which to base treatment decisions.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/smoking-and-antibodies-to-cyclic-citrullinated-peptides-predict-persistently-high-levels-of-survivin-in-early-rheumatoid-arthritis/