الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
Forty five rheumatoid patients and 20 control
subjects were included in this study. The patients fulfilled
the American Rheumatism Association (ARA) criteria
for definite R.A.
All the patients and controls were subjected to:
A. Full history was taken with special attention to
functional evaluation of the patients according
to (A.R.A.), four major functional classes of R.A.
B. All cases were then subjected to a thorough clinical
examination.
C. Hand and Wrist X-rays were done for diagnosis of
erosions.
D. Laboratory investigations:
- Complete blood picture.
- Erythrocyte sedimentation rate (E.S.R.).
- Determination of uric acid level in the serum
- Estimation of IgA, IgG. and IgM levels in sera.
- Antinuclear antibodies (A.N.A.) determination.
- Latex agglutination test for R.A. with titre.
- Rose Waaler test with titre.
- Skin biopsy.
Then rheumatoid patients in this study were divided into
two groups:
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Group (1): They were of poor functional capacity
(grade III and IV), all of them were suffering from
vasculitis as shown by biobsy and erosive changes as
shown in wrist X-ray.
Group (2): They were of good functional capacity
(grade I and II), they were not suffering from vasculitis
and had no erosive changes in their wrist X-ray.
Our results showed that a clinical subgroup of
patients having at once the patterns of small joints involvement,
acute onset and without extra-articular manifestations
had a better outcome.
Statistical analysis of the results showed that the
level of IgA, IgG and IgM were significantly increased
in rheumatoid subjects in comparison with control group.
Serum IgA level in group (1) (those with erosive changes
and poor functional capacity), was significantly higher
than in group (2) (those without erosive changes and with
good functional capacity). from above mentioned data,
serum IgA was considered a useful marker of the disease
activity in R.A. Since humoral immune responses in the
gut are mainly of the IgA type, a microbial triggering
agent acting across an IgA secreting organ such as the
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gut, may playa role in the pathogenesis and activity
in R.A., and this point needs further studies.
Also, it was found that IgM level in the group of
rheumatoid patients with vasculitis, were significantly
above normal.
Our results revealed that there was no significant
difference between both rheumatoid groups as regard the
presence or absence of R.F. or its titre.
The clinical usefullness of two tests for R.F.,
(latex test and Rose Waaler test), were compared. It
was found that latex test was more sensitive (100%)
than specific (90%) and Rose Waaler test was more specific
(100%) than sensitive (80%).
A number of laboratory tests,in addition to immunoglobulins
and R.Fs had prognostic significance, were done
they include:
Haemoglobin:
It was noticed that rheumatoid groups having lower
haemoglobin level compared to control. Also group (1)
had a lower haemoglobin level compared with group (2) ,and
this difference was statistically significant.
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- E.S.R.:
There was a significant increase in the level of
E.S.R. in rheumatoid groups than control group and also
the level of E.S.R. in group (1) (whose suffered from
erosive R.A.) was higher than group (2), and this
increase was statistically highly significant.
- Eos inophil s:
No eosinophilia in our patients, was observed.
Antinuclear antibodies (A.N.As): Four (19%)
patients in group (1) (erosive group), had positive
A.N.As while only 2 (8.3%) patients in group (2) (non
erosive group) had positive A.N.As, but statistically
this increase was not significant. This result may
be due to the use of one titre for patient serum (1/20).
There is now substantial evidence that treatment
of R.A. with disease modyfying drugs like steroid, gold
salts or penicillamine, may favourably alter the course
of R.A. However, side effects occur in 20-40% of patients
treated with such medications. Since these reactions
may occasionally be life threatening, we recommend
that specific drugs tend to be reserved for those with
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more severe disease. An early identification of patients
with poor prognosis (group (1) in the present study) is
important because there is evidence that specific treatment
is most effective early in the course of R.A.