الفهرس 
Bacteria, mycobacteria and mycoplasmaOnly 14 pages are availabe for public view
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Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease characterized by synovitis, bone destruction and degradation of articular cartilage, it can also affect other organs. The inflamed synovium leads to erosions of the cartilage and bone and sometimes joint deformity. Pain, swelling and redness are common joint manifestations. RA can begin at any age and is associated with fatigue and prolonged stiffness after rest. There is no cure for RA, but new effective drugs are increasingly available to treat the disease and prevent deformed joints. In addition to medications and surgery, good self-management, including exercise, are known to reduce pain and disability. Cytokines plays an important role in immunopathogenesis of rheumatoid arthritis. Interleukin 35, a member of IL-12 cytokine family, has been identified as an immunosuppressive/ anti-inflammatory cytokine that may be involved in various autoimmune diseases including RA. IL-35 promotes the propagation of CD4+CD25+ T cells along with remarkable elevation of IL-10 levels and markedly restrains the differentiation of Th17 cells. IL-35 significantly attenuated the synovial hyperplasia, cartilage, and bone erosion. IL-35 may represent a novel therapeutic agent for RA. The aim of this study was to determine serum level of IL-35 in patients with rheumatoid arthritis to throw some light on its role in rheumatoid arthritis and its correlation with activity and severity of the disease. This study was carried out on 30 patients suffering from RA diagnosed according to The 2010 American College of Rheumatology (ACR) /European League Against Rheumatism (EULAR) 2010 classification criteria for rheumatoid arthritis and 20 healthy volunteers matched for age and sex with the patients. Both patients and control groups were selected from the Rheumatology, Rehabilitation and Physical medicine outpatient clinic and inpatient department of Tanta university hospitals. Inclusion criteria: - Patients with rheumatoid arthritis. Exclusion criteria: - Other autoimmune diseases. - Current infections. All patients were subjected to the following: 1- Complete history taking. 2- General clinical examination. 3- Locomotor system examination. 4- Assessment of disease activity using Disease Activity Score-28 (DAS-28). 5- Laboratory investigations included: - Complete blood count. - Erythrocyte sedimentation rate. - C - reactive protein. - Rheumatoid factor. - Anti cyclic citrullinated peptide antibodies. - Measurement of serum interleukin-35 levels by enzyme linked immunosorbant assay. The results of this study were calculated, tabulated and statistically analyzed. The results of this study could be summarized as follows: • In RA patients group, age ranged from 25-67 years while in control group it ranged from 28-65 year. There was no significant difference between patients and control groups as regards age. • In RA patients group, there were three males (10%) and 27 females (90%), while in control group there were two males (10%) and 18 females (90%). • There was no significant difference between RA patients and control groups as regards gender distribution. • In RA patients group, Hb level ranged from 8 to 12.3 gm/dl, while in control group it ranged between 13.0 and 14.9 gm/dl. There was significant decrease between RA patients and control groups as regards Hb. • In RA patients group, ESR 1st h ranged from 18 to 110 mm/h, while in control group it ranged between 9 and 23 mm/h. • There was significant increase between RA patients and control groups as regards ESR 1st hour. • In RA patients group, CRP ranged from 0 to 48 mg/dl, while in control group it ranged between 0 and 6 mg/dl. There was significant increase between RA patients and control groups as regards CRP. • In RA patients group, RF ranged from 8 to 256 IU/ml, while in control group it ranged between 4 and 12 IU/ml. There was significant increase between RA patients and control as regards RF. • In RA patients group, anti-CCP ranged from 10 to 270 U/ml, while in control group it ranged between 6 and 11U/ml. There was significant increase between RA patients and control groups as regards anti-CCP. • Serum interleukin-35 levels were lower in RA patients group than control group with highly statistically significant difference between both of them. • In RA patients group serum IL-35 level was high in 8 patients and low in 22 patients, while Serum IL-35 level was high in all control group. There was significant decrease between RA patients and control groups as regards serum IL-35 level. • In RA patients group serum IL-35 level was low in one male and high in two males, while serum IL-35 level was low in 21 female and high in six females. There was no significant difference between serum IL-35 and sex. • According to DAS-28 grading: -Serum IL-35 level was high in all three patients on clinical remission. -Serum IL-35 level was low in four out of six patients with low disease activity. -Serum IL-35 level was low in 14 out of 17 with moderate disease activity. -Serum IL-35 level was low in all four patients with high disease activity. There was significant negative association between serum IL-35 levels and grading of DAS-28. • Serum IL-35 level in RA was low with old age, increased disease duration, prolonged morning stiffness and increased number of tender joints, number of swollen joints, VAS, DAS-28, ESR 1ST hour, CRP and RF. • Serum IL-35 level was low with decreased Hb level • There was no significant association between serum IL-35 levels in RA and sex and anti-CCP level.