الفهرس 
Rheumatoid Arthritis (RA)Only 14 pages are availabe for public view
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory multisystem disease of unknown cause. It has been claimed that vitamin D in its active form (1, 25(OH)2D3) exerts an immuninoregulatory activities. Increased reactive oxygen species (ROS), lipid peroxides, and low antioxidant status may influence the course of the disease. Active Vitamin D3 (1, 25(OH)2D3) is a fat-soluble vitamin that its principle action is to increase the absorption of calcium and phosphate ions from the intestine and directly affect the calcification process. Beside its crucial role in calcium metabolism and bone remodeling, active vitamin D3 considered an immunomodulator. The process induces synovitis (infiltration of inflammatory cells such as macrophages and lymphocytes), synovial hyperplasia with neo-vascularization, and excess synovial fluid, which causes joint swelling, stiffness, and pain. The final results are the destruction of the articular cartilage and the erosion of bone in the joints. Oncostatin M (OSM) is a pro-inflammatory cytokine that plays a crucial role in the pathogenesis of RA. We aimed to correlate between Rheumatoid arthritis activity and vitamin D deficiency in urban and rural areas. Fifty patients with RA and 30 healthy controls matched for age and gender were included into our prospective, cross-sectional study. Serum 25(OH) D3(vitamin D3) is measured as it is the precursor of 1, 25(OH)2D3 (active vitamin D) which has a very short half live measured by Radioimmunoassay (RIA) and RA activity was assessed by measuring serum OSM by Elisa. Oxidative stress was assessed by measuring serum malondialdehyde (MDA) and enzymatic antioxidant status by estimating superoxide dismutase (SOD) and glutathione peroxidase (GPX). The results of the present work are highly suggestive of the importance of vitamin D3 supplementation in active RA patients. The serum level of vitamin D3 is significantly lower in RA patients when compared to their level in the control group (p-value < 0.001). There is no statisitical significance between patients living in urban or rural areas as regard the measured parameters .On the other hand, levels of OSM were significantly higher in the RA patients than their levels in the healthy control subjects (p-value < 0.001). A negative correlation was observed between serum vitamin D3 and OSM in RA patients.
The serum levels of SOD, and GPX were significantly lower in RA patients when compared to their level in the control group (p< 0.001). On the other hand, levels of MDA were significantly higher in the RA patients than their levels in the healthy control subjects (p<0.001). We found highly statistical negative correlation between 25(OH) D3 with MDA levels (P <0.001and r = -0.787). On the other hand, SOD and GPX positively correlated with 25(OH) D3 levels (P < 0.001 and P<0.006 and r = 0.507 and r =0.383 respectively). We found a statistically significant negative correlation between vitamin D3and disease activity score 28(DAS-28) and erythrocyte sedimentation rate (ESR) level (p=0.010 & 0.006 respectively). Through our study it was evident that low vitamin D3 and disturbed anti-oxidant levels are prevalent in the Egyptian RA patients more than the healthy population. We also reported a significant association between vitamin D3 level with various disease activity parameters and OSM level. A routine vitamin D3 and antioxidant supplementations to RA patients is recommended for better prognosis.