Serum RANKL levels in Chinese patients with ankylosing spondylitis: a meta-analysis

Abstract

Objective We aimed to determine the association between serum receptor activator of nuclear factor-kappa B ligand (sRANKL) levels and ankylosing spondylitis (AS) in Chinese patients. Methods The PubMed, Cochrane Library, Embase, Chinese Biomedical Database, Web of Science, China National Knowledge Infrastructure, VIP, and Wan Fang databases were searched for studies conducted before October 1, 2020, without language restrictions. STATA version 12.0 and Revman version 5.3 were used to analyze the data. The standard mean differences (SMDs) and corresponding 95% confidence intervals (95% CIs) were calculated. Results Twelve clinical case–control studies, including 585 patients with AS and 423 healthy controls, were included. The combined SMD for sRANKL suggested that the sRANKL level was significantly higher in Chinese patients with AS than in healthy controls (SMD: 3.27, 95% CI 2.11–4.43, P < 0.00001). Serum RANKL-related factor osteoprotegerin (OPG) levels (SMD: 0.86, 95% CI 0.09–1.64, P < 0.03) were lower in the Chinese patients with AS than in healthy controls, and the RANKL/OPG ratio (SMD = 1.05, 95% CI 0.64–1.46, P < 0.00001) in Chinese patients with AS was approximately the same as that of healthy controls. Subgroup analysis indicated that patients from North and South China had higher sRANKL levels than controls; the sRANKL levels of patients from South China were higher in the subgroup with a Bath Ankylosing Spondylitis Functional Index (BASFI) of > 4 than those of patients in other subgroups. In terms of duration, patients with AS for > 8 years had higher sRANKL levels than health controls. Other subgroup analyses were conducted by region, language, source of control, age, and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). In these subgroups, the sRANKL levels were significantly higher in the patients with AS than in healthy controls. The BASFI and BASDAI were sources of heterogeneity. Conclusions The sRANKL levels are higher in Chinese patients with AS, especially among those from South China. sRANKL levels may be positively correlated with the pathogenesis of AS among Chinese patients.

Increased Prevalence of Autoimmune Rheumatologic Diseases in Patients With Primary Hyperparathyroidism

“…PTH is the main regulator of the RANK/RANKL/OPG system, which controls bone remodeling. RANKL levels have been shown to increase in AS patients compared to controls [ 30 ]. Between 18.7% and 62% of AS patients have osteoporosis, and 10% have a collapse fracture [ 31 ].…”

Axial spondyloarthritis: one year in review 2023

“…However, their results did not show any significant improvement in disease activity after the administration of symbiotics (28). Another probable player in AxSpA onset could be the receptor activator of nuclear factor-kappa B ligand (sRANKL); indeed, its serum level was found significantly increased in Chinese patients with AS, apparently in relation with functional compromission of patients and disease duration (29). It is well known that infections could act as a significant trigger in the onset of autoimmune diseases.…”

“…• An imbalance in lymphocytes subsets seems to be involved in ax-SpA pathogenesis and the administration of symbiotics does not seem to correct it (26-28). • RANKL system could be related to AS onset (29). • A Klebsiella pneumoniae infection may have a role in AS development (30).…”