الفهرس 
Rheumatoid arthritisOnly 14 pages are availabe for public view
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Abstract
Rheumatoid arthritis ( R.A.) is the most common chronic inflammatory disease of the joints. The definition of R.A. is sometimes imprecise, but usually describes a symmetrical, persistent and destructive polyarthritis often associated with rheumatoid factor and / or positive results for anti cyclic citrullinated peptide antibodies (A.C.C.P.) .This disease is characterized by joint swelling , tenderness and destruction of synovial joints , leading to severe disability and premature mortality
A growing body of observational data has linked RA to an increased risk of cardiovascular disease (C.V.D. ) and death Multiple mechanistic links between systemic inflammation and accelerated atherosclerosis have been described in the setting of R.A.
Among R.A. patients with well - controlled clinical disease , a substantial proportion may exhibit C.R.P. levels associated with high risk for C.V. events . It has also been suggested that patients with rheumatoid arthritis may be at a special risk of sudden thrombotic arterio - occlusive events in the relative absence of warning symptoms .
Traditional risk factors for cardiovascular disease (hypertension, smoking ,hypercholesterolemia ) account for about 50% of all coronary heart disease events in the general population . Several thrombotic variables have also been linked to the future risk of developing myocardial infarction or stroke . Added to von Whllebrand factor (vWF) and tissue plasminogen activator( t-PA ) , fibrinogen is the best established of these thrombotic variables .
The purpose of this study is to assess the level of plasma fibrinogen in well controlled rheumatoid arthritis patients and also in active disease states and to evaluate its cardiovascular risk in these patients ..
This study was carried out on 50 rheumatoid arthritis patients with variable degrees of severity and activity , 25 patients were in an active state ( 14 in moderate activity and 11 in high activity ) added to 25 patients in an inactive state , all patients were taken from the outpatient clinic of rheumatology – Benha university hospital, compared to 15 normal healthy subjects of the same age and sex.
All patients were subjected to full history taking and clinical examination, diagnosed according to A.C.R. ,also laboratory investigations including E.S.R., C.R.P. , serum cholesterol , triglycerides R.F. , and serum fibrinogen were done added to plain X- ray , E.C.H.O. and E.C.G.
After obtaining the results , they were tabulated , subjected to statistical analysis from which we have found the following : -
- A statistically significant difference between R.A. patients and controls as regarding laboratory variables including E.S.R. , serum fibrinogen , C.R.P. , cholesterol , triglycerides and R. F. ( *P < 0.01 ) .
- A statistically significant difference in serum fibrinogen level between active and inactive R. A. patients .
- A statistically significant + ve correlation between fibrinogen level and physical findings of disease activity which reflects a proportionate rise of fibrinogen and D.A.S.28.
- A statistically significant + ve correlation between fibrinogen level and other inflammatory markers ; C.R.P. and E.S.R. (* p < 0.01 ) .
- A statistically significant difference between R.A. patients and controls as regarding both E.C.G. and E.C.H.O. findings , but there was a non significant difference between active and inactive R.A. patients as regarding the same variables .
- A statistically significant + ve correlation between serum fibrinogen level and C.V.D. in all R.A. patients .
Our study concluded that there was a significant difference in fibrinogen level between active and inactive .R. A.
According to results of our study , we had found a significant difference in fibrinogen level between R.A. patients and controls , previously ,it was concluded that the degree of elevation of fibrinogen level in R.A. patients including those with little Joint activity ( 100 mg / dl ) is consistent with a significant contribution to C.V.D. ( 1.8 fold increase ) . Also , it was found that fibrinogen offers a causative link to C.V. events since it is a known thrombotic mediator .
Based on the results of our study , this may raise some important issues:
• Importance of evaluation of serum fibrinogen as an inflammatory and C.V. risk marker in R.A. patients.
• Thorough cardiovascular evaluation of R.A. patients and follow up by E.C.G. and / or E.C.H.O. as those patients are more prone to cardiovascular insults .
Untill the risk / benefit ratio of escalating currently available immunesuppressive anti-rheumatic agents in patients with minimal clinical disease activity in R.A. is established, as it is now declared that fibrinogen can remain elevated in R.A. patients despite excellent clinical disease control . Thus , a therapeutic management arises for physicians aiming to aggressively manage clinical disease activity and C.V. risk in R.A. Aggressive control of conventional ,modifiable C.V.D. standard of risk factors should represent the best available C.V. care .
Serum fibrinogen evaluation in all R.A. patients may be of a great value in impending C.V. events, This may be a fruitful area for research. We recommend for this study to be extended on a larger number of patients with different grades , severity and duration of disease activity and its correlation with C.V. complications , also with its degree of severity in R.A. patients .