الفهرس 
Rheumatoid ArthritisOnly 14 pages are availabe for public view
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Abstract
V
SUMMARY
itamin D is an essential neuro-steroid with a major role in central and
peripheral nervous system physiology. It can be obtained from the diet
or synthesized in the skin during sunlight exposure.
Vitamin D also regulates the immune response through a different
mechanism, such as reducing antigen presentation, inhibiting the pro
inflammatory T helper type 1 profile and activating regulatory T cells. It also
suppresses proliferation and immunoglobulin production and retards
differentiation of B-cell precursors into plasma cells. These data support a
vitamin D deficiency role in the development and progression of RA and
other autoimmune diseases.
Long-term vitamin D deficiency may lead to decreased immune response
and chronic inflammation, which may cause disabling pain. Individuals with
vitamin D deficiency often report increased pain perception, which has been
referred to hyperinnervation and hypersensitivity in nerve fibers.
The aim of this work is to study the effect of different vitamin D levels on
clinical and laboratory characteristics of RA and to investigate the relationship
between neuropathic pain (NP) and serum-active metabolite of vitamin D in
patients with RA.
This was a case control cross sectional study that was conducted in
Fayoum University Hospital and included 120 participants which were
classified equally to 60 patients with rheumatoid arthritis (RA), and 60 healthy
age & sex matched controls. The patients were diagnosed according to the
American College of Rheumatology/ European League against Rheumatism
SUMMARY
2
2010 ACR/EULAR criteria. They were recruited from Rheumatology &
Rehabilitation department clinic in in the period from October 2018 to July 20.
SUMMARY
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The patients were classified equally into: group (A) which consisted of RA
patients complaining of neuropathic pain and group (B) which contained RA
patients without neuropathic pain. All the patients were evaluated clinically and
laboratory. The patients with neuropathic pain underwent nerve conduction studies
at neurological unit, Neurology department in Fayoum University Hospital.
This study showed that RA patients had lower vitamin D level than control
subjects as regard the mean value of vitamin D blood level (23.54 ±14.03 vs.
37.84 ±13.82). Moreover, the proportion of patients with vitamin D deficiency
was higher among RA than control group (61.7% vs. 16.7%).
It was shown that RA patients with low vitamin D were of urban residence than
rural (89.5% vs. 48.8%) also, there was a significant difference between vitamin D
status and duration of disease.
There was significant relation between patients with vitamin D deficiency
compared to patients with insufficient or sufficient vitamin D as regard the mean
value of Anti-CCP. No relation between disease activity and vitamin D level.
RA patients with neuropathic pain (NP+) showed significant lower vitamin D
level than RA patients without neuropathic pain (NP-). Moreover, the proportion
of patients with vitamin D deficiency was higher among RA patients showing
neuropathic pains (NP+) than non-neuropathic RA patients (NP-) (66.7% vs.
56.7%).
It was shown that there was a significant difference between RA patients
without neuropathic pain (NP-) and RA patients with neuropathic pain (NP+)
regarding LANSS, VAS, MHAQ, DAS-28, TJC.
SUMMARY
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There was significant relation between disease activity and LANSS score where
the mean level of LANSS was significantly higher in patients with severe
activity (16.09±4.847) than moderate activity (10.91±5.02) and patients in
remission (8±3.46).
Nerve Conduction Studies showed RA patients with neuropathic pain had
significant delaying of latency and reduction of conduction velocity of motor and
sensory branches of median, ulnar and tibial nerves denoting entrapment (CTS)
as well as mononeuritis multiplex (MM).
Moreover, this study illustrated that there was significant negative correlation
between vitamin D level and right median sensory latency, but there was positive
correlation between vitamin D level and bilateral tibial motor conduction
velocities.
On the other hand, there was no significant correlation between vitamin D and
other variables of nerve conduction studies.