Periostin and rheumatic diseases: early insights from a systematic review and meta-analysis

Periostin regulates angiogenesis, inflammation, and fibrosis, key processes in the pathophysiology of rheumatic diseases (RDs). However, its association with RDs has not been assessed. We conducted a systematic review and meta-analysis of studies reporting circulating periostin in RD patients and healthy controls. We searched electronic databases from inception to 30 November 2024 for relevant articles and assessed the risk of bias and the certainty of evidence using the JBI critical appraisal checklist and GRADE, respectively. In 12 eligible studies, there was a non-significant trend towards higher periostin concentrations in RD patients (standard mean difference, SMD = 0.46, 95% CI -0.07 to 0.98, p = 0.089; I² = 94.2%, p < 0.001). The results were stable in sensitivity analysis. There were no significant associations between the SMD and age, male-to-female ratio, number of participants, or publication year. However, we observed significant periostin elevations in studies investigating systemic sclerosis and rheumatoid arthritis but not osteoarthritis. Significant periostin reductions were observed in studies investigating ankylosing spondylitis and dermatomyositis. Furthermore, the SMD was significant in studies conducted in America, but not Asia or Europe. Our study suggests significant periostin elevations in rheumatoid arthritis and systemic sclerosis. Such elevations may reflect a more pronounced dysregulation of angiogenesis and fibrosis when compared to other RDs. Further research is warranted to investigate periostin concentrations in a wide range of RDs with various inflammatory, angiogenic, and fibrotic features and whether periostin is useful for diagnosis, prognosis, and monitoring in this patient group (PROSPERO registration number: CRD42024623501).