الفهرس 
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Abstract
Rheumatoid arthritis is a chronic, systemic, inflammatory autoimmune disorder causing symmetrical polyarthritis of large and small joints, producing an inflammatory synovitis that often progresses to destruction of the articular cartilage and ankylosis of the joints.
Although the exact cause of RA has not been established, many factors contribute to its pathogenesis including immunological, genetic and infectious factors. The breakdown of self-tolerance is a hallmark of this disease in the form of disordered adaptive immunity accompanied with disorders in the innate immunity as well.
Diagnosis of RA relies mainly on three aspects; clinical aspect, radiological findings and laboratory testing. Laboratory testing includes various tests amongst which the most prominent is RF, Anti-CCP and Anti-MCV.
Early diagnosis coupled with the appropriate treatment can secure favorable outcome of the disease. Treatment with DMARDS has been the mainstay in the last few years including MTX and other drugs.
Treatment with MTX has been accompanied with few pitfalls due to its wide range of systemic side effects. Hepatic fibrosis has been one of the prominent side effects of long use of MTX.
Hepatic monitoring is essential in RA patients on long term therapy with MTX. Liver markers, imaging studies and lastly liver biopsy are the well-established methods.
The aim of this study was to evaluate the reliability of Procollagen III amino terminal propeptide (PIIINP) in screening for hepatic fibrosis induced by long term MTX therapy in RA patients compared with FIB 4 score and ALT/AST ratio.
In the present study, the serum level of PIIINP was measured using ELISA technique in 90 RA patients, 60 of them were on MTX therapy for one year or more (group I) and 30 on other medications for RA (group II). The results were correlated with ESR, CRP, DAS28, RF, FIB-4 score, AST, ALT and AST/ALT ratio for the patients and the patient controls.
In the present study, the serum level of PIIINP was significantly higher in patients on MTX therapy (group I) compared to patients on other medications (group II).
Data from the present study confirmed the presence of positive correlation between Fib-4 score, AST/ALT ratio and PIIINP in patients on MTX therapy (group I).
Data from the present study also found that there was a statistically significant difference among the groups as regard MTX dose and duration and PIIINP levels.
Data from the present study confirmed the presence of statistical significant difference and negative correlation between PIIINP and Folic acid intake in group I where PIIINP levels were lower in patients on folic acid.