الفهرس 
Rhuematoid ArthritisOnly 14 pages are availabe for public view
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Abstract
The aim of this work is .to study bone turnover occurring inn rheumatoid arthritis patients using estimation of some biochemical
changes as an index of this bone turnover. Alkaline phosphatase
and its isoenzymes especially alkaline phosphatase bone isoenzyme
was estimated as an index of bone formation while the fasting
urinary calcium creatinine ratio as an index of resorption. Also
the levels of serum calcium and phosphorus were estimated to find
out any change which may associate bone turnover in rheumatoid
arthritis. This study aimed at finding out the relation between bone
turnover and drug therapy, duration of the disease and parameters
of the disease activity.
Forty female patients suffering from rheumatoid arthritis
comprised the material of this work. The patients were allocated
into two groups according to their drug therapy. the f{rst .group
comprised 20 patients receiving non steroidal anti-inflammatory
drugs while the second group comprised 20 patients receiving steroid
therapy.
Twenty healthy females-free from any relevant disease and
matched with the patients for age-included as a control group.
All patients were examined clinically while laboratory investigations
and x-ray examination were done in order to confirm the
diagnosis.
Serum calcium, phosphorus, alkaline phosphatase and its isoenzymes
(bone and liver fraction) were determined in the serum
of the patients in each group and compared with those obtained
from the control.
Fasting urinary calcium I creatinine ratio was estimated in
each group and compared with that obtained from 20 female controls
and also with each other.
In this study, the correlations of alkaline phosphatase isoenzymes
and fasting urinary calcium creatinine ratio versus parameters
of disease activity and duration of the disease were done
in each group.
The results of our study demonstrated that, the mean .calcium
levels in the serum from patients with rheumatoid arthritis was
(10.588 :!: 0.38 mg/100 ml) in the first group while in the second
group (10.305 :!: 0.42 1’!’g/100 ml), It was significantly higher
. than that of the controls (9.1 :!: 0.33 mg/IOO ml) but between
the first and the second groups there was non significant
difference.
The mean serum phosphorus levels of the patients (first
group 3.750 :!:0.15 mg/IOO ml) and second group 3.958 :!: 0.092
mg/IOO ml) was insignificantly different from that of the
controls (3.849 :!: 0.11 mg/IOO ml), Also these was non significant
difference between both groups.
The mean level of alkaline phosphatase in the serum of the
first and the second groups of the patients (17. 732:!:1.53 K.A. U./
100 ml and 16.961 :!: 1.07 K.A.U. / 100 ml)was significantly
higher than its mean level in the serum of the controls (10.085
:!: 0.7 K.A.U.). In the first group, it was higher than the ’second
groups but with insignificant difference.
The mean level of alkaline phosphatase bone isoenzyme in
the serum of rheumatoid arthritis patients were in the first group
(1.67 :!: 0.332 K.A.U./ 100 ml) and second group (0.999 :!: 0.22
K.A.t1. / 100 ml) while in the controls, it was 0.574:!: 0.122
K.A.U. /100 ml. This increase was highly significant greater in
the first group than that in the control while in the second
group it was insignificantly greater’ than controls and in the
first group it was higher than second group with insignificant
difference.
The mean level of alkaline phosphatase liver isoenzymes in
the first group (15.659 ~ 1.33 K.A.U./100 ml and in the second
group (15.962 ~ 0.985 K.A.U./100 ml) were highly significantly
greater than controls (9.510 :1:0.729 K.A.U./lOO ml), A non
significunt difference WIIS found between the first and second
group.
The mean value’ of fasting urinary calcium / creatinine ratio
in the second group (0.212 ~ 0.008) was highly significantly greater
than the controls (0.137 ~ 0.006) and also it was significantly
greater than the first group (0.181) which, in turn,
was highly significantly greater than controls.
A non significant correlation was found between the alkaline
phosphatase or its isoenzymes especially bone fraction (index of
bone formation) and .parameters of disease activity or duration of
the disease.
A highly significant correlation was found between’ fasting
urinary calcium/creatinine ratio (index of bone resorption) and
duration of the disease while there was 110nsignificant correlation
between this index and parameters of disease activity.
from the previous study we come to the conclusion that bone
turnover increased ill the patients with rheumatoid arthritis than
the controls as noticed from increased indices of both bone formation
(alkaline phosphatase bone isoenzyme) and bone resorption
(fasting urinary calcium: creatinine ratio).
Bone resorption was predominant especially in the group
treated with corticosteroids.
There was insignificant correlation between indices of bone
turnover and activity of the disease while there was significant
correlation between the index of bone resorption and duration of
the disease which may be due to prolonged impairment of physical
activity present in the patients with rheumatoid arthritis.
Serum calcium level was significantly higher in the serum of
the patients with rheumatoid arthritis than in the serum of the
controls but this increase in the calcium level in the serum of the
patient was still within the normal range while· non significant
difference between phosphorus serum level in the patients and
controls was found.