الفهرس 
Rheumatoid arthritisOnly 14 pages are availabe for public view
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Abstract
Rheumatoid arthritis is a disabling systemic autoimmune disease of unknown etiology characterized by a chronic inflammatory process that leads to the destruction of the synovial membrane of the small and major diarthrodial junctions, and is associated with a worsening quality of life and reduced life expectancy. Cardiac involvement has been observed without the clinical symptoms of heart disease and is one of the leading extraarticular causes of morbidity and mortality in RA. Interleukin-6 has been implicated in the pathogenesis of RA. The role of the variability of IL-6 production in the pathogenesis and severity of RA is genetically determined and its 174G/C promoter polymorphism is associated with disease susceptibility and activity and forms a genetic risk factor. The aim of this study was to detect IL-6 promoter gene polymorphism and its circulating level in RA patients and its association with disease activity, severity of joint damage and subclinical atherosclerosis. This study was carried out on sixty RA patients selected from the outpatient clinics of Physical Medicine, Rheumatology &Rehabilitation department of Tanta University Hospitals. The patients fulfilled the ACR / EULAR 2010 classification criteria of RA. Forty apparently healthy nonsmoker volunteers matched with the patients group as regard age and sex were used as control group. All patients were subjected to the following: Full medical history taking. Thorough clinical examination. Assessment of disease activity using DAS28. Functional assessment using Modified Health Assessment Questionnaire. Laboratory assessment: - Rheumatoid factor. - Erythrocyte sedimentation rate. - C reactive protein. - Anti cyclic citrullinated peptide antibody. - Total lipid profile: TC, TG, LDL-C, HDL-C, atherogenic index (TC/ HDL-C & LDL-C/ HDL-C). - Measurement of: IL-6 in plasma. - Genotyping: Polymerase chain reaction was performed to determine the genotypes of IL-6 promoter gene polymorphism. Radiographic assessment by the simplified erosion and narrowing score to assess erosions and narrow joint space in both hands and feet. Musculoskeletal ultrasound assessment: by using the US7 Score to assess erosions and disease activity. Measurement of Intima media thickness of common carotid artery using ultrasonography to detect the presence of subclinical atherosclerosis. The results of this study could be summarized as follows: 1. Plasma IL-6 levels were significantly higher in RA patients than in healthy controls. 2. There was significant positive correlation of plasma IL-6 levels with clinical, laboratory and US parameters of disease activity (DAS28, laboratory (ESR, CRP) and US (PD_ synovitis). 3. There was significant positive correlation of plasma IL-6 levels with modified health assessment questionnaire, and erosions detected by both radiology and ultrasonography. 4. There was no significant correlation between plasma IL6 levels and lipid profile. 5. There was significant positive correlation of plasma IL6 level with IMT. 6. The polymorphic C allele was significantly more frequent in RA patients than controls. 7. Plasma IL 6 levels were significantly higher in CC genotype than GG & GC genotypes. 8. The values of intima media thickness were significantly higher in CC genotype when compared to other genotypes, while there was no significant difference in the lipid profile parameters among different genotypes. 9. Joint damage scores assessed by x-ray and US were significantly higher in RA patients carrying GC & CC genotype than those carrying GG genotype.