الفهرس 
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Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease that has a major effect on health status and quality of life and imposes a substantial economic burden on patients and society (Norman et al., 2016). Joint involvement is the characteristic feature of rheumatoid arthritis. In general, the small joints of the hands and feet are affected in a relatively symmetric distribution (Temprano and Smith, 2014).
In contrast Ankylosing Spondylitis (AS) and related spondyloarthritis (SpA) are characterized by axial disease involving the sacroiliac joints (SIJ) and spine, causing inflammatory back pain (IBP) (Vandooren et al., 2009).
Sacroiliitis is an atypical joint involvement of RA, bilateral sacroiliitis cases accompanying late RA have been reported in the literature, although rarely (Çalık et al., 2009).
An increased prevalence of low back pain was also associated with HLA-B27 in the patients with RA (Mera-Varela et al., 2013). Thought the presence of HLA-B27 could modify the phenotypes of patients with RA towards resembling SpA. There have been some reports in this direction (Flato et al., 2002). One of these studies reported an increased prevalence of clinical enthesitis in patients with early arthritis fulfilling RA criteria (Rundback et al., 1993).
The aim of this study was to determine the frequency of axial and or peripheral spondyloarthropathic features in patients with rheumatoid arthritis.
One hundred patients (83 female, 17 male) who fulfilled the 1987 ACR classification criteria for Rheumatoid arthritis (Arnett et al., 1988), were included in this study, and 20 healthy ”age and sex matched” individuals were served as a control group.
All patients were subjected to: full history taking, clinical examination, plain X-ray of both hands and wrists, standard pelvic X-rays for examination of the SIJ and lumbar spine, MRI of SIJ for patients who have inflammatory back pain with normal x ray of sacroiliac joints or have suspicious of sacroiliitis in x ray, musculoskeletal ultrasonography for enthesis, and laboratory evaluation (ESR, CRP, RF for all patients, and HLA-B27 for patients who fulfilled any of spondyloarthropathy criteria).
The present study reported high frequency of IBP (52% according to Calin criteria and 45% according to experts’ criteria) and other SpA features such as radiographic sacroiliitis (22%), clinical enthesitis (90%), and gluteal pain (63%) in patients with RA. Ultrasonographic enthesitis according to MASEI score (≥ 18) was found in 72 patients (72%). HLA-B27 was investigated in 58 patients and it was positive in 21 patients (35.21%). No other SPA features were detected in our RA patients.
The number of RA patients who fulfilled any criteria of SPA are 58 patents (58%) with overlap occurred between each of them, ESSG criteria was fulfilled in 56 patients(56%), Amor’s criteria was fulfilled in 26 patients (26%), ASAS classification criteria for axial spondyloarthritis was fulfilled in 27 patients (27%).