الفهرس 
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Abstract
Rheumatoid arthritis (RA) is a chronic progressive autoimmune disease characterized by an inflammatory infiltrate of immune cells, in particular T-cells , which represent approximately 40% of the synovial cellular infiltration and participate in a number of inflammatory and destructive events, such as synovial hyperplasia, pannus setting, cartilage and bone erosion, and joint destruction .
The aim of this study is to compare the clinical pictures, ultrasonography finding and serum and synovial IL17 A level in RA patients & their relation to disease activity and severity.
The study included one hundred patient suffering from RA and 50 age and sex matched control was recruited from the outpatient clinic of Physical Medicine & Rehabilitation Department Faculty of Medicine Menoufia University Hospital in the year 2013-2014. The study included both sex. The selection of patients based on 2010 — Revised American College of Rheumatology (ACR) criteria for RA. The study group is divided into three group’s mild, moderate& severs according to disease activity score DAS28.
Patients of the three groups were subjected to the following:
1- Full medical history (age, sex, occupation).
2- Clinical examination.
3- Laboratory investigations:
- Complete blood count.
- Erythrocyte sedimentation rate.
- C- Reactive Protein.
- Serum rheumatoid factor.
- Liver function tests (SGOT, SGPT).
- Renal function tests (Serum creatinin, Blood urea).
- Anti- CCP antibody.
- IL- 17A in the serum and synovial fluid by ELISA
- IL- 17A in the synovial fluid by Arthrocentesis (synovial fluid
aspiration) from the inflamed joint.
4- Radiography:
- Plain X-rays of the hands and wrists antero-posterior view.
- Power Doppler ultrasound
5- Statistical analysis of data.
The results showed the following :
The studied RA patients were aged from 20 to 69 years and their disease duration ranged from 2 to 23 years.
There were significant increases in and RF titer, Anti CCP titer, grades of erosion as regard to Larsen score in RA patients with increased disease activity.
There were negative correlation between laboratory measures as regard HB, PLT & WBC and clinical singes as regard NTJ, NSJ& VAS, and positive correlation between SGOT, SGPT, S.creatinin& ESR and clinical study (NTJ, NSJ, VAS).
There were significant increases in IL17A level in the blood & synovial fluid in the patients groups with increased disease activity in RA patients, and in serum IL17A level between patients and control.
There were significant positive correlation between IL17A level in the blood & synovial fluid in RA patients.
There were significant positive correlation between the clinical signs of disease activity and parameters and subscales of disease severity and serum IL17A level in the patients groups.
There were significant positive correlation between RF titer &Anti CCP titer as a parameter of disease severity & the level of IL17A in the blood of RA patients.
There were significant increase in IL17A level in the blood in RA patients & high grades of wrist erosion as a parameter of disease severity.
There were significant increase in IL17A level in the blood of RA patients with increased erosion of the wrist, knee and 2nd MCP as regard musculoskeletal US measurement.
There were significant increases in IL17A level in the blood of RA patients in the three groups with increased effusion of the wrist, knee as regard musculoskeletal US measurement.
There were significant increase in IL17A level in the blood of RA patients in the three groups with increased vascularity of the wrist, knees &2nd MCP as regard musculoskeletal US measurement.
There were significant increase in IL17A level in the blood of RA patients in the three groups with increased synovial thickness of the wrist, knees &2nd MCP as regard musculoskeletal US measurement.
There were significant increases in the erosion and synovial thickness of knee, wrist & 2nd MCP in the three groups of RA with increased disease activity.
There were significant increases in the effusion of knee & wrist between the three groups of RA with increased disease activity.