الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Rheumatoid arthritis is the most severe and most destructive of all joint diseases. RA is a chronic multisystemic auto-inflammatory disease. The hallmark of RA consists of synovial joint inflammation, leading to bone and cartilage destruction. Symptoms such as joint pain, swelling, and fatigue are disease-specific stressors that tax the adaptive resources of patients and heighten the risk for patient reported declines in function as well as reports of emotional disturbance which together create enormous psychological and financial loss for RA patients.
Visfatin, a growth factor for B lymphocyte precursors, is another pro-inflammatory adipocytokine, seen in liver, skeletal muscles and bone marrow and produced by visceral WAT (White Adipose Tissue), with potent effects on immunity and inflammation in addition to their metabolic activities. Serum visfatin levels were increased in patients with RA as well as, its expression in synovial fluids and inflamed synovium . Recently, reports have suggested the significant role of adipocytokines such as visfatin in mediating joint damage.
The aim of this current study was to assess the role of visfatin in RA regarding disease activity, function disability and radiological damage.
The study included 30 RA patients and 30 apparently healthy normal control subjects. The RA patients were diagnosed according to the 2010 ACR/EULAR classification criteria for RA with exclusion of those who had diabetes mellitus, endocrine disorders, associated rheumatologic diseases, metabolic diseases and other diseases with increased serum visfatin level.
All patients were subjected to clinical evaluation of the musculoskeletal system that entailed examination of PIPs, MCPs, wrists, elbows, shoulders and knee joints. Disease activity was assessed by DAS 28. Functional disability was assessed by HAQ-DI. Radiological assessment of both hands and wrists by SvH scoring method. Laboratory parameters including ESR, CRP, RF, CBC, SGPT, SGOT, blood urea and serum creatinine were assessed in patients and serum level of visfatin in both patients and control subjects.
There was no statistically significant difference between patient and control group regarding age and sex. Among patients, 96.7% were females and the age ranged from 23 - 75 years, with a mean of 44.57 ± 11.34 years. The mean of DAS 28 score was 4.94 ± 1.08 and that of HAQ-DI was 1.16 ± 0.41. Regarding EAM, 17 patients (56.7%) had EAM, 15 patients (50%) had anaemia. The JSN score for the hands ranged from 5.0 - 82.0 with a mean of 31.33 ± 20.81. The JE score for the hands ranged from 0.0 - 46.0 with a mean of 15.83 ± 13.03. Regarding the laboratory results, 80% of the patients were RF positive, the mean of CRP was 11.51 ± 8.28 mg/dl and most of them had elevated ESR 1st hour with a mean of 36.27 ± 17.21mm.
The serum level of visfatin was significantly higher in patient group than its level in control group (P ≤ 0.001). Serum visfatin was correlated with DAS28, JSN, JE among the patient group. There was statistically significant positive correlations were found between serum level of visfatin and CRP, ESR and HB among the patient group.
There were no statistically significant correlations between serum level of visfatin and HAQ-DI, age, height, weight, BMI and disease duration among patient group.
In conclusion, visfatin serum level is significantly higher in RA patient group than in the healthy control group and positively correlated with DAS28, JSN, JE, CRP, ESR and HB among the patient group. But, it did not correlate with the other laboratory parameters, HAQ or BMI. Visfatin has a role in pathogenesis of RA regarding joint inflammation and joint destruction. Visfatin is not correlated with function disability. Visfatin has a role in joint damage.