الفهرس 
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Abstract
Inflammatory musculoskeletal involvement is one of the most common manifestations of SLE. Incidence ranges from 69% to 95% of patients and represents the heralding symptom in 70% of SLE cases (Petri, 1995 and Cervera et al., 2003). The majority of SLE patients develop non-deforming arthritis (Alarcon-Segovia et al., 1988). However, in 5–15% of cases, joint involvement progresses to deforming arthropathy, which might show as erosive or non-erosive (Jaccoud’s arthropathy) (Reilly et al, 1990). Over the past years, it was suggested that anti-CCP antibodies are associated with erosive arthritis in SLE, but the exact significance of their presence in SLE remains unclear (Zhao et al., 2009). Musculoskeletal US has already been reported as a useful tool for assessment (Ossandon et al., 2009), monitoring treatment (Torrente-Segarra et al., 2009) and defining complications in SLE patients with articular involvement (Piga et al., 2010). However, incidence and the nature of hand, wrist and foot US abnormalities differ depending on the study (Wright et al., 2006 and Delle Sedie et al., 2009).
This study was carried out on 30 SLE patients fulfilling the 1997 ACR classification criteria for systemic lupus erythematous (Hochberg, 1997) compared to 20 age and sex matched healthy controls.
The patients and control groups are classified into the following groups:
1) The SLE patients group (group I), which is further sub divided into two groups:
• group IA: SLE patients with clinical arthritis.
• group IB: SLE patients without clinical arthritis.
2) The control group (group II).
Serum anti CCP (ACPA) was measured in both patients and control using the quantitative enzyme immunoassay technique (ELISA).
In addition, group I was subjected to Imaging of wrists, hands and forefeet by musculoskeletal ultrasonography using GSUS and PDUS.
The activity of the disease was assessed by the means of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2k) (Gladman et al., 2002). The functional status of patients was assessed by visual analogue scale for pain (VAS) (McCormack et al., 1988) and Arabic version Health assessment questionnaire disability index (HAQ-DI) (Abdel-Nasser, 1993).
Our results showed a a high prevalence of joint involvement (67%) and tenosynovitis (57%) in SLE patients using MSUS. A significant correlation was detected between the presence of arthritis and US findings in the form of GSUS and PDUS (p <0.0001, p =0.001) respectively. Clinical arthritis was detected in (90%) of those who had positive US finding and (10%) of them had no arthritis at the time of examination. A significant Positive correlation was found between GSUS findings and parameters of functional assessment (HAQ, VAS), SLEDAI 2k disease activity score (p =0.004, p =0.001, p =0.003) respectively. Power Doppler signal was detected in 10 (56%) of the 18 patients presented with arthritis at time of examination. Power Doppler was significantly correlating with laboratory markers of disease activity (ESR, CRP, C3, C4) (p =0.006, p =0.038, p=0.017, p=002) respectively. Another positive correlation was found between PD and parameters of functional assessment (HAQ, VAS) , SLEDAI 2k disease activity (p =0.013, p =0.012, p <0.0001) respectively. Erosions were found in 7 SLE patients (23%); all of them were presented with clinical arthritis. Anti cyclic citrullinated peptide antibody was positive in 4 (13.3%) SLE patients, 3 of them had an erosive arthritis. A significant positive correlation was found between erosions and ACPA (anti CCP) (p =0.007).