الفهرس 
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Abstract
Rheumatoid arthritis is a chronic autoimmune disease that affects primarily the small joints leading to chronic pain, bone erosions and deformity. It is often accompanied with systemic manifestations termed extra-articular manifestations.
Interstitial lung disease (ILD) is recognized as a serious extra-articular complication of RA and accounts for a major cause of morbidity and mortality in RA patients. It has been postulated that chronic inflammatory activity beside a triggering environmental factor are important for the development of ILD in RA. One of the changes occurring in the context of inflammation is development of ACPA which is implicated in higher frequency of extra-articular manifestations including pulmonary complications.
The aim of this study was to assess the relation of ACPA to interstitial lung disease in RA patients.
The study included 40 RA patients fulfilling the 2010 ACR-EULAR classification criteria for RA with no other causes of interstitial lung disease as interstitial pneumonia & asbestos exposure or any other causes of autoimmune diseases & multiple connective tissue diseases (MCTD) that affects the level of ACPA like Systemic lupus erythematous, systemic sclerosis, autoimmune hepatitis and hepatitis C virus.
Full history was taken from the patients. General and musculoskeletal clinical examination was done. Disease activity was assessed by DAS28. The level of ACPA, CRP, ESR were measured. All patients were subjected to high resolution CT (HRCT) chest echocardiographic examination, x-ray hands and feet and pulmonary function test (PFTs).
Patients were subdivided into two categories according to ACPA positivity (twenty ACPA positive patients and twenty ACPA negative patients). ACPA positive patients aged (51.90 ± 8.11years) and the other twenty ACPA negative patients aged (54.65 ± 6.55 years).
There was no significant difference between the two studied groups regarding age, gender or smoking index which was (4.03 ± 8.80 pack/year) for ACPA positive patients and (6.21 ± 10.37 pack/year) in ACPA negative patients. There is no statistically difference of significance in the duration of RA disease between all cases regardless of ACPA titer.
The mean of DAS28 was 3.59 ± 0.84 in ACPA positive patients and 3.44 ± 0.87 in ACPA negative patients. There was no significance between HAQ scores of patients and being +ve or –ve for ACPA in his or her serum (p 0.765). Having +ve ACPA in the patient sera is more likely accompanied with x-ray finding in hands and feet with statistical difference from ACPA –ve titer (p = 0.026).
Although there was no significant relation between pulmonary involvement manifestation & ACPA titer (p= 0.669), statistically significant restrictive pattern of PFTs in ACPA +ve patients and high prevalence of HRCT changes accompany ACPA +ve sera indicate ILD which is thus having more prevalence with high ACPA titer.
In conclusion, Presence of ACPA may be related to development of interstitial lung disease among RA patients and all RA patients especially those with high titer of ACPA should be routinely evaluated with a thorough HRCT chest to assess their pulmonary status.