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Article
The Association of Smoking with the Extra-Articular Manifestations in Rheumatoid Arthritis Patients

Authors: Mohammed Hadi Al-Osami --- Ali Abdul Majid Allawi --- Tahir Hussein Al-Saadawi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 1 Pages: 146-152
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Rheumatoid Arthritis (RA) is a chronic systemic autoimmune inflammatory disease that affect all ethnic groups throughout the world, the main characteristic symptom is persistent synovitis of diarthroidal joints often symmetrical resulting in pain, stiffness, and limitation of movement. Smoking is the most established environmental risk factor for development, severity,and extra-articular manifestation of RA..OBJECTIVE:To assess the association between smoking and appearance of extra-articular manifestation.PATIENTS AND METHODS:A cross sectional study was conducted on 244 patients with RA meeting the American College of Rheumatology Criteria for the classification of RA. Patients data were obtained via face - to- face interview performed by rheumatologist. RA disease-related data, such as disease duration, drug use (all anti-rheumatic drugs , glucocorticoid use and NSAID's), history of smoking which is classified into current smoker, former Smoker ( patient discontinue smoking for at least three months ), and never smoker , also number of cigarette per day were also recorded.Extra-articular manifestation of RA were assessed in all patient by thorough physical examination, and the patient send for appropriate investigation to confirm the diagnosis. RESULTS:Among 244 patients with RA, 76.2% were women and 23.8% were men, the females were significantly predominate the study samples (P<0.001). The mean (SD) age are 46.9 ± 11.4, the age varies with smoking history (P=0.043). It is significant to find that two third of patients (69.3%) not have smoking history (P<0.001) because majority of patients were female.Smoking is significantly increase rheumatoid factor positivity (P=0.013), Smoking is significantly associated with rheumatoid nodules (P<0.001), secondary Sjögren syndrome (P<0.001), and eye involvement (P=0.002), while there is no significant association with other extra-articular manifestations.. CONCLUSION:There is significant association between smoking and RA extra-articular manifestations


Article
Oral Findings in Rheumatoid Arthritis Patients

Author: Ali Mihsen Hussein Al-yassiri
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2013 Volume: 6 Issue: 1 Pages: 1584-1590
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: Rheumatoid arthritis affects women more than men 3:1. Rheumatoidarthritis can start at any age but most commonly occurs in the 30 – 50 age groups.Rheumatoid arthritis also has oral, occular manifestations, dryness, swelling ofsalivary glands, xerostomia, oral and mucosal ulcerations. The aims of this study were todetermine the oral manifestations in newly and old (previously) diagnosed Rheumatoidarthritis patients and compare it with healthy controls (without systemic diseases) and finallyto find the accurate prevalence of these manifestations in rheumatoid arthritis patients.Materials and methods: Seventy two (72) subjects were incorporated in this study, theywere divided into 2 groups, Rheumatoid arthritis patients group: fifty – two (52) patients withrheumatoid arthritis, they were (11) males and (41) females, Seventeen newly diagnosedrheumatoid arthritis untreated patients. Thirty five rheumatoid arthritis patients were onmethotrexate treatment. All rheumatoid arthritis patients were without any other systemicdisease. Healthy control group: - twenty healthy control subjects with no signs and symptomsof any systemic disease. They were sex and age matched to rheumatoid arthritis patients.Results: The results revealed that the main oral manifestations of Rheumatoid arthritispatients were angular cheilitis, candidial infection, tempromandibular joint disorder, oralulceration, and xerostomia. In old diagnosed rheumatoid arthritis patients, the percentages oforal ulcerations, tempromanbdibular joints, and xerostomia was significantly higher than innewly diagnosed rheumatoid arthritis patients. While the percentage of angular chilitis andcandidial infections in newly diagnosed rheumatoid arthritis patients was significantly higherthan in old (previously) diagnosed patients.Conclusion: Rheumatoid arthritis is a chronic disease in which Saliva is a goodrecommended sample for evaluation and estimation of the severity of disease as well astreatment follow up. Oral ulceration and xerostomia are the most prominent oralmanifestations coincide with the progress of the disease and treatment.


Article
The Relationship among Interlukin-10 ,Interlukin-6 with anti-cyclic citrullinated peptide antibody, C-reactive protein ,Rheumatoid factor in patients with Rheumatoid Arthritis
التهاب المفاصل الريثاني الانترلوكين 14 , النترلوكين

Author: Ahmed Abbas Hasan احمد عباس حسن
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2015 Volume: 11 Issue: 20 Pages: 190-196
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

Rheumatoid arthritis (RA), the most severe disease affect the joint and also the most common systemic autoimmune disease, affecting approximately 1% of the adult population .We investigate the serum levels of IL-10 and IL-6 in patients with Rheumatoid arthritis. About forty patients with Rheumatoid arthritis (30 female and 10 male) with ages ranged between (20-70) years were taken from (Al-Hussein Medical City/Kerbala).Control group consisted of 20 healthy people were free from signs and symptoms of arthritis were matched in age and gender with patients, and had no history for any arthritis problem .IL-10 (IL-10-EASIA Kit, DIAsource) (IL-6 ELISA kit ,immunotech),(Anti CC-P ELISA kit ,Medizym/Germany ) ,(RF ELISA Kit Euroimmun/Germany) were measured using the enzyme-linked immunosorbent assay (ELISA) method and CRP Vital kit using quantitative turbidimetry method . t-test , ANOVA and Pearson correlation were used to analyze results by using SPSS version 22. P-value ≤ 0.05 was considered significant. IL10,IL6,Anti-CCP,CRP and RF were increased significantly (p< 0.05) in patients compared with control group, So increasing of IL10,IL6,Anti-CCP,CRP and RF values at mild stage (41.4±1.3),sever stage(54.8±0.8),sever stage(952±114), server stage(49.3±1),sever stage (181.3±11) respectively increased significantly value (p< 0.05) among the stages, The results revealed no significant value (p>0.05) among the age groups and according the gender groups, While there were highly significant correlation (p< 0.05) found among studded parameters

يعتبر التهاب المفاصل الريثاني من اشد الأمراض التي تصيب المفاصل وكذلك هو أكثر أمراض المناعة الذاتيةشيوعا", والذي يصيب حوالي 1% من الأشخاص البالغين ,نفذت هذه الدراسة على 04 حالة مرضية ) 04 حالة سريريهللمرضى الإناث و 14 للمرضى الذكور( مع أعمار تتراوح بين 04 04 سنة, جمعت العينات من مدينة الحسين الطبية في -محافظة كربلاء ,احتوت مجموعة السيطرة على 04 شخص خالين تماما من أعراض وعلامات الإصابة بالتهاب المفاصلالريثاني وقد تطابقوا من حيث الجنس والعمر مع المرضى ,أيضا" اخذ بنظر الاعتبار خلوهم تماما من تاريخ الإصابةبالمرض.تم فحص الانترلوكين 14 , الانترلوكين 6 ,مضاد السايكلك سترولينيتد ببتايد و عامل الروماتزم بطريقة الامتزازالمناعي المرتبط بالأنزيم , بينما تم قياس البروتين المتفاعل C باستخدام طريقة مقياس الكدورة الكمي , حللت البياناتإحصائيا" الرزمة الإحصائية ) SPSS version 22 - -ANOVA Pearson correlation (, وكذلك تم مقارنة القيمبواسطة العينة المستقلة ) T-test (, إذا كان مستوى المعنوية اصغر أو يساوي 4040 مع المقارنة بمجموعة السيطرة فتعتبرعالية المعنوية . بينت النتائج ارتفاع مستوى المعنوية للانترلوكين 14 ,الانترلوكين 6,مضاد السايكلك سترولينيتد ببتايد,البروتين المتفاعل C 4.5 (,المرحلة الحادة ± 1.0 (, المرحلة الحادة) 00.5 ± وعامل الروماتزم في المرحلة المعتدلة ) 01.011 ( بالتتابع بين هذه المجاميع ,من ناحية أخرى ليست هناك فروقات معنوية ± 110±300.0 (, المرحلة الحادة ) 151.0 (لهذه العوامل بالنسبة لمجاميع العمر والجنس, بينما كانت هنالك فروقات معنوية عالية بين العوامل المذكورة .


Article
Dyslipidemia and biological agents among a sample of patients attending Baghdad Teaching Hospital

Authors: Atta AH Mousa --- Ali Hussein --- Nazar Abdull Latif
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2016 Volume: 29 Issue: 3 Pages: 129-132
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Tumor necrosis factor-alpha (TNF-α) is a multifunctional pro-inflammatory cytokine that had a major role in the etio-pathogenesis of psoriasis and psoriatic arthritis, rheumatoid arthritis, inflammatory bowel disease (IBD), and other dermatologic and rheumatologic conditions. A new era in the treatment of rheumatic diseases began with the development of TNF-α-inhibitorsObjectives: To evaluate lipid profile changes after anti-TNF therapy in patients with psoriatic, rheumatoid arthritis and ankylosing spondylitis Patients & Methods: A prospective study included 90 patients presenting with ((30) Psoriatic arthritis, (30) ankylosing spondylitis (30) rheumatoid arthritis (who were treated with anti-TNF therapy (infliximab, rituxmab etanercept) and assessed during follow-up period after 6month of therapy.Results: Regarding (TC,TG, HDL and LDL) Significance differences(p<0.000) were seen after biological therapy with infliximab infusion in patients with psoriatic arthritis , The current study had Significance differences regarding TG and HDL after 6 month of treatment of rheumatoid arthritis patients with rituximab., Significance differences were seen regarding TG and LDL in ankylosing spodylitis patients treated with etanerceptConclusion: Significance differences were seen regarding lipid profile and antitumor necrosis factor alpha therapy regarding psoriatic ,Rheumatoid arthritis and ankylosing spondylitis


Article
Effect of Oxidative Stress on Iraqi Rheumatoid Arthritis Patients

Authors: Weaam F. Hussain --- Wisam Kadhum H. Al-Hashemi
Journal: Al-Nahrain Journal of Science مجلة النهرين للعلوم ISSN: (print)26635453,(online)26635461 Year: 2018 Volume: 21 Issue: 2 Pages: 28-31
Publisher: Al-Nahrain University جامعة النهرين

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Oxidative stress is an imbalance between oxidants and antioxidants, play an important role in the development of Rheumatoid Arthritis. Rheumatoid Arthritis regard as a chronic, autoimmune disease. The aim of the study to assess levels of some oxidative stress biomarker in Rheumatoid Arthritis. This study involves 80 Rheumatoid arthritis patients and 30 healthy subjects as control groups. Analysis on serum samples was Malondialdehyde, Albumin, and total Bilirubin. The obtained data showed significantly increasing (P<0.01) in level of oxidant parameter Malondialdehyde and significantly decrease (P<0.01) in endogenous antioxidant albumin and total bilirubin in comparison with the control group which may be due to increased activity of immune system which involves reactive oxygen species in its action. The reactive oxygen species of originated from the immune system have the crucial role in oxidative stress situation in Rheumatoid arthritis


Article
Assessment of Disease Activity in Rheumatoid Arthritis: A Comparative Study of Clinical Evaluation with Ultrasonography

Authors: Ali Abdul-Rahman Younis --- Nizar Abdul Lateef Jassim --- Abdullateef Aliasghar*
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2016 Volume: 15 Issue: 2 Pages: 202-210
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT: BACKGROUND: In patients with rheumatoid arthritis (RA) a poor relation on an individual joint basis, has been observed between clinical signs of synovitis and ultrasound measures of synovial disease. OBJECTIVE:To compare the traditional clinical measures of disease activity with the ultrasound (US) features of synovitis, and investigate the relationship between composite US measures and disease activity score in 28 joints (DAS28), clinical disease activity index (CDAI), their components and other variables of disease activity in RA.METHODS:Fifty patients with RA were enrolled in this study. The following 28 joints including bilateral glenohumeral, elbow, wrist, metacarpophalangeal (MCP), proximal interphalangeal (PIP) of the hands, and knee joints were assessed for tenderness and swelling. DAS28 and CDAI were determined for each patient. A systematic US examination was carried out by a radiologist for the 28 clinically examined joints. Each joint was evaluated for the presence of synovial hypertrophy (SH), power Doppler (PD) signals, and effusion. The following composite US measures of synovial disease were made: SH joint count (SHJC), effusion joint count (EJC), PD joint count (PDJC), SH index (SHI), and PD index (PDI).RESULTS: Joints with tenderness only showed significantly less PD scores than other groups. SH and PD signals were detected in 32.1% and 27.8% of the Nil group respectively. SHJC and SHI showed moderate correlation with TJC and high correlation with SJC, evaluator global assessment (EGA), patient global assessment (PGA), DAS28, CDAI, and erythrocyte sedimentation rate (ESR). PDJC and PDI showed moderate correlations with tender joint count (TJC), and high correlation with swollen joint count (SJC), EGA, DAS28, and ESR. PDI showed high correlation with PGA, and CDAI. CONCLUSION:Traditional clinical signs used in the evaluation for disease activity may bear different relation to the US features of synovitis (SH, PD signals). Composite US count and indices for SH and PD relate significantly to the DAS28-ESR, CDAI, and their components..


Article
Prevalence of dyslipidemia and its association with disease activity in patients with rheumatoid arthritis attending Rizgary Teaching Hospital in Erbil City
انتشار عسر شحميات الدم وارتباطه بنشاط المرض في المرضى الذين يعانون من التهاب المفاصل الروماتويدي في مستشفى رزكاري التعليمي في مدينة أربيل

Authors: Niaz J. Al-Barzinjy --- Shnow Burhan Hameed
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2017 Volume: 21 Issue: 2 Pages: 1781-1788
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: This study aimed to measure the prevalence of dyslipidemia in patients with rheumatoid arthritis compared with healthy control people and find out the correlation between dyslipidemia and disease activity.Methods: A prospective case-control was done. A total of 100 female patients with rheumatoid arthritis were included in the study. This study was conducted at the Rheumatology Out-patient Clinic in Rizgary Teaching Hospital, Erbil City over seven months from April 2013 to October 2013. Patients who fulfilling the 1987 revised American College of Rheumatology and 2010 American College of Rheumatology/European League against rheumatism classification criteria for rheumatoid arthritis and 100 healthy female age-matched controls with the mean age for both groups being 45. Fasting lipid profiles of cases and controls were estimated after an overnight fasting of 12 hours. Association between lipid profile and disease activity using disease activity score DAS 28, inflammatory markers (CRP and ESR) was also determined. Results: Rheumatoid arthritis patients showed a higher prevalence of associated dyslipidemia (47%) in comparison to control (5%), P = 0.004. There was a significant reduction in serum high density lipoproteins (P = 0.04), with significant elevation of serum total cholesterol, triglyceride, low density lipoprotein and very low density lipoprotein (P = 0.001, 0.004, 0.04 and 0.05, respectively) in comparison to controls. There was a significant relation between disease activity score 28 and serum high density lipoproteins (P <0.001) and there was a significant relation between ESR and triglyceride (P = 0.05).Conclusion: is frequent among the patients with rheumatoid arthritis and highly associated with active rheumatoid arthritis. Serum high density lipoproteins significantly reduced while other parameters of lipid profiles significantly increased in comparisons to control.


Article
The physiological evaluations of C-reactive protein, anti-cyclic citrullinated peptide antibody and RF in the rheumatoid arthritis patients of Al-Nassyria hospital

Author: Talib F. Abbas
Journal: Muthanna Medical Journal مجلة المثنى الطبية ISSN: 2226146x Year: 2015 Volume: 2 Issue: 1 Pages: 1-4
Publisher: Al-Muthanna University جامعة المثنى

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The assessment of autoantibody before clinical onset of Rheumatoid Arthritis, has been helped in establishing early diagnosis. Recent studies on RA described many inflammatory conditions that precede joints inflammations. Anti-CCP and IgM-RF were evaluated in 10-RA patients and in same number as control. Anti-CCP was detected by ELISA and IgM-RF using latex agglutination test, while the CRP was measured by latex turbi-imetric immunoassay, and the ESR was measured by Westergren method. The values of Anti-CCP antibody is more sensitive than the other tests, in 50% were positive, and 50% negative. CRP measures were fluctuated around 37% positive and 63% were negative. ESR values have been shown a significant increase in 90% positive, whereas 10% negative. RF show a significant increase by 60% positivity. The positive value was higher for anti-CCP antibodies in comparison to other markers for RA patients. Interestingly, there were not significant relation between anti-CCP antibody titers and inflammatory markers such as ESR and CRP. However, there is a tighten relation between Anti-CCP and RF had been confirmed.

Keywords

Rheumatoid Arthritis --- Anti-CCP --- RF


Article
Rheumatoid Arthritis of the Temporomandibular Joint, A Clinical and Radiographical Study

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To determine the extent of temporomandibular joint (TMJ) involvement in patients with rheumatoid arthritis compared with a matched control group. And to evaluate the correlation between clinical findings and radiographical findings.The studied sample comprised 50 patients with rheumatoid arthritis, age ranged from 18 to 72 years with the mean age of 40.98 (± 13.67.The control group consisted of 63 subjects age–matched non rheumatic patients: Each patient was informed about the purpose of the investigation and that it would include questionnaire, clinical and radiographical examinations. The radiographic examination was done by using double TMJ lateral panoramic technique.It was found that 64% of RA patients complained of two or more clinical signs and symptoms compared with 44% of the control group ,the difference was statistically significant (P< 0.05), the most important clinical findings were pain on palpation and on opening and closing, crepitation, limitation of jaw opening and morning stiffness, difference were statistically significant (P< 0.05). Among the clinically involved subjects in study RA group 28 subjects (56%) had bilateral involvement, 3 subjects (6%) had right side involved and 1 subject (2%) had only left side involvement. The radiographic involvement of TMJ was found in 16 subjects (32.0 %) of the study group compared with 1subject (1.6 %) of the control group. There is a highly statistically significant difference between the study group and the control group (P< 0.05); the most common radiographical finding was erosion. Complete condylar destruction was found in 1 patient which resulted in anterior open bite. Among involved cases 11 subjects (22%) had bilateral involvement, 5 subjects (10%) had unilateral involvement (3subjects (6%) had left side involved and, 2 (4 %) subjects had only right side involved. There was no correlation between clinical and radiographic find ings. There was correlation between the extent of radiographical findings and duration of Rheumatoid Arthritis p value (P< 0.05).The clinical and radiographic findings were more common in RA group than in control individual. The clinical and radiographic findings are not always bilateral in TMJs of patients withrheumatoid arthritis.


Article
Serum Anti-Cyclic Citrullinated Peptide (Anti_CCP) Antibody Level in Rheumatoid Arthritic Patients with and without Nodal Osteoarthritis

Author: Ahmed A. Gassid
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 2 Pages: 151-156
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Rheumatoid Arthritis (RA) is chronic systemic inflammatory disease affects synovial joints , articular structures and extra articular , the prevalence rate occurs aprox in about 1% of population Anti citrullinated peptide/protein antibody (Anti-CCP) antibody are autoantibodies(antibodies directed against one or more of the individuals own proteins) frequently detected in RA patients during inflammation. citrulline is incorporated enzymatically into proteins .The current study is a trail to ensure that Anti-CCP marker is more specific and sensitive for diagnosis of RA patients and to detect the effect of the presence of other disease like NOA on Anti-CCP valueOBJECTIVE:Evaluation of Anti-CCP Ab level in RA patients with and without NOA.The serum level of Accp_Ab is estimated using ELISA technique in patients with RA and NOA.SUBJECTS AND METHODS:The studied group includes 30 RA patients (24 females and 6 males), who fulfilled four or more of the 1987 ACR criteria compared with 30 RA+NOA patients (23 females and 7 males) also fulfilled four or more of the 1987 ACR criteria for the classification of Rheumatoid arthritis and nodal osteoarthritis group. Blood samples were taken from three groups to analyze and measure the serum levels of Anti-CCP.RESULTS:Result of investigations were compared with that for the 30 apparently healthy control individuals who matched the patient´s group in age and sex.The result of the study showed that majority of patients is females (80%) for RA patients and (76.6%) for RA+NOA patients (with females: males 4:1 & 3.28:1 for RA and RA+NOA respectively). Moreover, the mean age for RA, RA+NOA and control groups are: 48.03±12.95y, 51.3±11.8y and 37.43±12.57years respectively.It was observed from the result that there is a higher positivity of Anti-CCP in the patients sera( 76.7% for RA+NOA cases and 70% for RA cases) in comparison with healthy control group (0.0%) so there is highly significant difference (p<0.001).While the quantitative estimation of Anti-CCP antibodies showed that its level was higher among sera of RA+NOA patients in addition to RA patients (53.59±33.29 RU/ml and 52.28±48.99 RU/ml respectively) in comparison with healthy control group 2.88±2.50 RU/ml.CONCLUSION:We found that Anti-CCP is a good & specific marker for diagnosis of RA & RA can be differentiated from other disease by measuring this marker.Moreover, Anti-CCP Ab level in RA patients does not significantly affected by the presence of NOA.

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