Bechman Katie, Dalrymple Anthony, Southey-Bassols Charles, Cope Andrew P, Galloway James B
Centre of Rheumatic Diseases, Weston Education Centre, King's College London, Room 3.46, Third Floor, London, SE5 9RJ, UK.
BMC Rheumatol. 2020 Nov 2;4(1):70. doi: 10.1186/s41927-020-00154-3.
The B cell chemoattractant CXCL13 is a promising biomarker in rheumatoid arthritis (RA), with a plausible role in supporting diagnosis, monitoring disease activity and as a prognostic value. It is a key chemokine driving the formation of lymphoid follicles within the inflamed synovium. The objective of this systematic review was to evaluate the role of CXCL13 as a viable biomarker in RA.
We conducted a systematic literature review of all published cohort and randomised controlled trials evaluating the role of CXCL13 in RA. The primary outcomes were; i) CXCL13 levels in RA patients compared to healthy controls, ii) the correlation between CXCL13 and markers of disease activity, and iii) the association between CXCL13 and treatment response.
The search produced 278 articles, of which 31 met the inclusion criteria. Of the 12 studies evaluating CXCL13 expression in early or established RA, all reported higher levels than that seen in healthy controls. Twelve of sixteen studies reported a weakly positive correlation between CXCL13 and markers of disease activity including DAS28 and swollen joint count, with rho values between 0.20-0.67. In 2 studies, CXCL13 levels correlated with ultrasonographic evidence of synovitis. Eighteen studies assessed CXCL13 in response to therapeutic intervention. The majority signified a fall in levels in response to treatment including biologics and Janus kinase (JAK) inhibition. In some, this reduction was only seen in treatment responders. High CXCL13 levels predicted failure to achieve disease remission with csDMARDs. The evidence for treatment prediction with biologics was conflicting.
Despite evidence to suggest a role in diagnosing RA and in detecting synovitis, the heterogeneity of studies included in this review limit our ability to draw robust conclusions. At present there are inadequate results to justify the routine use of CXCL13 as a biomarker in RA routine clinical practice.
B 细胞趋化因子 CXCL13 是类风湿关节炎（RA）中一种很有前景的生物标志物，在辅助诊断、监测疾病活动及预后评估方面可能发挥作用。它是驱动炎症滑膜内淋巴滤泡形成的关键趋化因子。本系统评价的目的是评估 CXCL13 作为 RA 中一种可行生物标志物的作用。
我们对所有已发表的评估 CXCL13 在 RA 中作用的队列研究和随机对照试验进行了系统文献综述。主要结局包括：i）RA 患者与健康对照者的 CXCL13 水平；ii）CXCL13 与疾病活动标志物之间的相关性；iii）CXCL13 与治疗反应之间的关联。
检索到 278 篇文章，其中 31 篇符合纳入标准。在 12 项评估早期或确诊 RA 中 CXCL13 表达的研究中，所有研究均报告其水平高于健康对照者。16 项研究中的 12 项报告 CXCL13 与包括 DAS28 和肿胀关节计数在内的疾病活动标志物之间存在弱正相关，rho 值在 0.20 - 0.67 之间。在 2 项研究中，CXCL13 水平与滑膜炎的超声证据相关。18 项研究评估了治疗干预后 CXCL13 的变化。大多数研究表明，包括生物制剂和 Janus 激酶（JAK）抑制剂在内的治疗可使 CXCL13 水平下降。在一些研究中，这种下降仅见于治疗有反应者。CXCL13 水平高预示使用传统合成改善病情抗风湿药（csDMARDs）无法实现疾病缓解。生物制剂治疗预测的证据存在矛盾。
尽管有证据表明 CXCL13 在诊断 RA 和检测滑膜炎方面有作用，但本综述纳入研究的异质性限制了我们得出有力结论的能力。目前，尚无足够结果证明在 RA 常规临床实践中常规使用 CXCL13 作为生物标志物是合理的。
