The Diagnostic Significance of Serum Sclerostin in Early Detection of Rheumatoid Arthritis in Syrian Patients

Background: Rheumatoid arthritis (RA) is associated with joint deformities and local bone erosions. Sclerostin is an inhibitor of the Wnt pathway and drives to reduce bone formation. Aims: Our study aimed to compare the diagnostic significance of sclerostin with anti-CCP (anti-cyclic citrullinated peptide; normal level<20 IU/ml, and rheumatoid factor (RF; normal level<16 IU/ml) for the early diagnosis of rheumatoid arthritis in Syrian patients. Methods: This study contained fifty-eight RA patients and thirty healthy individuals who were equally age- and sex-matched. Serum sclerostin and serum anti-CCP (IgG) levels were evaluated by using the enzyme-linked immunosorbent assay (ELISA). RA activity was assessed based on disease activity scores (DAS28). Results: Our results indicated that serum levels of sclerostin levels were higher in the RA group than in the healthy group (p<0.001). There was a positive correlation between serum sclerostin and DAS28-ESR (r=0.413, p=0.001). By ROC curve, the most optimal cut-off value of sclerostin was 249.69 pg/ml (AUC was 0.910 with 95% confidence interval (CI) values (0.852-0.969), sensitivity of 87.9%, and specificity of 93.3%) [Odds Ratio (OR) and P-value: 102, P< 0.0001]. In RA patients, the sensitivity and specificity of anti-CCP were 74.1% and 90%, and 70.6% and 86.6% of RF, respectively. Conclusion: Increased serum sclerostin may aid as a new prognostic biomarker for evaluating the activity of RA. Sclerostin showed higher sensitivity and specificity than anti-CCP and RF-IgM antibodies. Therefore, sclerostin is a sensitive and specific biomarker for early diagnosis of rheumatoid arthritis.