الفهرس 
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Abstract
Rheumatoid arthritis (RA) is the most common auto- immune inflammatory arthritis in adults (elmick et al , 2008). The primary presenting symptoms are pain, stiffness, and swelling of the joints resulting in impaired physical function. These symptoms are often accompanied by constitutional symptoms such as fever and malaise (Grassi et al ,1998).
The etiology, or cause, of RA is unknown. Many cases are believed to result from an interaction between genetic factors and environmental exposures
( Silman et al,2001).
Gastro-esophageal reflux disease (GERD) is a chronic disorder of the upper gastrointestinal tract with global distribution .GERD is a common chronic disorder prevalent in many countr (Vakilies et al , 2006).
The mechanism of GERD symptoms in RA patients is unclear. A well known histological disorder in GI system in RA should be amyloidosis, in which excessive serum amyloid, an acute phase reactant protein produced by liver in chronic inflammatory diseases, deposit within GI mucosa causing dysfunction of GI tract. This condition is rather well known in lower GI tract, which often manifests severe diarrhea, but can also be observed in upper GI tract in RA (Kuroda et al , 2012). This study aimed to investigated the frequency of GERD and the correlation between GERD and the clinical characteristics of RA including patient’s global assessment (PGA) .
In this study, the FSSG questionnaire evaluate GERD patients’ reflux symptoms. The FSSG questionnaire is a GERD-specific questionnaire produced by Kusano et al and developed in Japan (Kusano et al , 2004).
use FSSG scoring, as it can evaluate not only the acid-reflux related symptoms but also the dyspeptic symptoms (Danjo et al , 2009). FSSG is a widely used questionnaire for the diagnosis of GERD (Furuta et al , 2011) and also for evaluating the effectiveness of the treatment (Sakamoto et al , 2010).
Fifty RA patients diagnosed according to ACR/EULAR 2010 classification criteria for rheumatoid arthritis . They were recruited from the Rheumatology and Rehabilitation Department, Faculty of Medicine, Beni-sueifUniversity.
All patients were subjected to:
1. Full history taking and full detailed clinical examination.
2. Routine laboratory investigations.
3. Disease activity was assessed according to DAS28 score , Clinical Disease Activity Index (CDAI), Simple Disease Activity Index (SDAI) and patient’s global assessment (PGA).
4. The MHAQ was used for measuring the functional disability of patients with RA.
5. GERD was assessed using Frequency scale for symptoms of gastro-esophageal reflux disease questionnaire(FSSG)
The RA patients were 3males (6%) and 47 females (94%) ; the age of our patients ranged from 17 and 70 years with a mean age 43.6 ± 13.12 years. Disease duration of patients ranged between 1 and 17 years with a mean duration 5.8 ± 3.7 years.
Frequency Scale for the Symptoms of GERD (FSSG) in rheumatoid arthritis patients 26 patients (52%) had GERD compared to 24 (48%) with no GERD
The results obtained were statistically analyzed and summarized as follows:
• There was no statistically significant difference between patients with GERD and patients free of GERD regarding sex (p>0.05).
• There was no statistically significant difference between GERD and GERD free subjects regarding age.
• There was no statistically significant difference between GERD and GERD free subjects regarding disease duration.
• GERD had significantly higher levels of MHQA, PGA, EGA, TJC and SJC than that of GERD free group (p<0.05).
• GERD had significantly higher levels of CRP, DAS, SDAI, CDAI and FSSG score than that of GERD free group (p<0.05).
• positive correlation between FSSG score and MHQA (p<0.05).
• positive correlation between FSSG score and each of SJC (p<0.05) and CDAI (p<0.05).
• strong positive correlation between FSSG score and each of CRP (p<0.05) ,DAS (p<0.05) and SDAI (p<0.05).