الفهرس 
INTRODUCTION and Aim of the work.Only 14 pages are availabe for public view
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Abstract
Rheumatoid arthritis is a common, chronic, disabling disease with significant morbidity and mortality (Emery et al., 1999). Presence of autoantibodies is one of the characteristics of this disease (Bang et al., 1994). One of these is the antibody directed against ”Keratin” AKA (Young et al., 1979). Initial studies using rat oesophageal epithelium as the substrate demonstrated that sera from patients of rheumatoid arthritis frequency had antibodies which bind to the profilagrin protein of the stratum corneum of ths skin (Vincent et al, 1989). In addition, it was suggested that the presence of this antibody was the most specific serological test for Rheumatoid arthritis (Wagner et al., 2000). It has been suggested that the risk of severe joint destruction and radiographic damage is higher in RA patient with positive AKA (Meyer et al., 1997). Furthermore, antikeratin antibody above certain titre was rarely found in patients who did not have rheumatoid arthritis (Cordonnier et al., 1996). The aim of the present study was to: 1- Study the value of anti-keratin antibody in diagnosis of RA and SLE. 2- Investigate whether AKA correlates with disease severity and activity in RA. 3- Compare disease pattern in AKA positive and AKA negative RA patients. The study comprised 46. RA patients diagnosed according to the revised ACR criteria (Arnett et al., 1988) and 20 SLE patients diagnosed according to the revised ACR criteria for classification of SLE (Tan et al., 1982) and 20 healthy adults contol matched for age and sex with our patients. All members, of this study were subjected to the following: 1- Thorough history taking with particular attention to the severity of pain and duration of morning stiffness. 2- Clinical examination: - General and local examination of the chest, heart, abdomen and CNS. - Examination of the locomotor system including: * Assessment of pain using a simple descriptive scale and visual analogue scale. * Assessment of joint tenderness using Ritchie articular index 1968. * Measurement of grip strength using a modified sphygmomanometer cuff. * Duration of morning stiffness in minutes. * Assessment of function using Steinbrocker score 1949. * Health assessment questionnaire (HAQ score). * Assessment of disease activity by Duke et al., (1983). * Assessment of disease severity by Walker et al., (1985). Investigations: A) Laboratory: i) Routine investigations including: - Complete blood picture. - ESR. - CRP. - Latex IgM rheumatoid factor (RF). - Antinuclear antibody (ANA). ii) Special investigations for assessment of anti-keratin antibody in serum by indirect immunofluorescence technique (Young et al., 1979). B) Radiology: Plain radiography for hand, feet, and other affected joints using Steinbrocker score (1949). Our results showed that the presence of AKA in the serum of 63% of the RA patients and only 10% of SLE patients and absence of this antibody in the serum of the control group. Diagnostic specificity of AKA in RA was 95% and PPV was 93.55%. Also we found the presence of this autoantibody in the serum of RA patients is significantly related to the disease activity (P<0.01) and to disease severity (P<0.02) and to the functional disability of the patients (P<0.01) and also to the radiographic damage of the patients joints (P<0.05). Conclusion: From this study we can confirm that AKA is a highly specific serological marker for the diagnosis of RA. Moreover, AKA positivety was found to be associated with disease activity and severity in rheumatoid patients. Thus, it might have some prognostic value and help in making early decision of more specific therapy for RA. While in SLE, it has no diagnostic or prognostic value. However, further studies with greater number of SLE patients may be required to ascertain this conclusion.