الفهرس 
Clinical Aspects of Rheumatoid ArthritisOnly 14 pages are availabe for public view
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Abstract
Rheumatoid arthritis (RA) is a complex disease of unknown cause, disputed origin, and variable clinical presentations.
However, RA is considered to be a multifactorial disease, resulting from the interaction of both genetic and environmental factors, which contribute to its occurrence and expression.
Its prevalence and incidence vary from one population to another and from time to time. In individual patients, it takes a variable course with remissions and exacerbations, and has a variable outcome, from a remitting disease leaving no damage to a severe disease bringing disability and even death.
Though a number of agents have proved useful in treating the disease, cure is elusive, and individual response to treatment is also variable.
Variations in the clinical expression, severity and outcome of the disease among different ethnic groups have been reported.
Differences in disease expression could be attributed to genetic or environmental factors, or a combination thereof. Thus, studies of RA in different populations might prove significant as more genetic markers are evaluated in different ethnic groups.
These investigations might have implications for management approaches to patients in different ethnic groups depending on the clinical expression of the disease and its severity in a particular population or ethnic group.
As the expression of RA in Egyptian patients had not been studied before, we aimed in this hospital based study to gather information about the sociodemographic, clinical, radiological and serological characteristics of the disease in Egypt.
This study involved 100 consecutive RA patients attending the outpatient clinic of Rheumatology and Internal Medicine Department of Ain Shams University Hospital.
All patients were subjected to full medical history and a thorough clinical examination, laboratory tests, radiological investigations as well as multiple interview questionnaires to assess various RA disease parameters.
This study revealed that the majority of Egyptian RA patients had severe disease activity, severe functional disability with more radiological damage.
Rheumatoid factor was frequently present in Egyptian RA patients and was significantly associated with severe disease activity, severe functional disability and more radiological damage.
We have demonstrated that extra-articular disease manifestations (EAMs) are common and have not become less frequent among patients with RA.
The most common EAMs found in our RA cohort were subcutaneous rheumatoid nodules (SCN). There was a significant causal relationship between rheumatoid factor positivity and occurrence of SCN in RA patients.
This study revealed that most of RA patients were treated by DMARDs; with methotrexate was the most frequent drug of choice used. None of our patients were treated by biologic therapies.
Depressive symptoms were not uncommon among our RA cohort with correspondence to a symptom severity of at least moderate depression.
Possible predictors of radiological damage among Egyptian RA patients where age of disease onset, disease duration, disease activity, functional disability and smoking.
Although our cohort was skewed toward more severe disease we believe that this is a benefit and not a limitation.
Our results illustrated the potential value of collaborative databases, with identical database architecture, to provide an opportunity to study associations between RA disease characteristics, therapies and outcomes at many sites all over Egypt.
However, the reasons for the contradictory features in the RA Egyptian patients still remain to be clarified. This study is hopefully a first step in promoting more precise studies on rheumatoid arthritis in Egypt.