الفهرس 
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Abstract
uvenile idiopathic arthritis (JIA) is the most common rheumatic disease that affects children and is a significant cause of both short- and long-term disabilities. Specifically, JIA is defined as arthritis of unknown etiology and its diagnosis requires clinical exclusion of other known conditions. Excessive delay in instituting advanced treatment for JIA can result in irretrievable damage to joints and other organs and impair skeletal maturation. Thus, early detection of JIA is critical to ensure its prompt treatment and to prevent long-term complications, including the likelihood of disability during childhood. Various publications concerning JIA indicated that the initial findings, clinical course, and laboratory findings of the disease are very variable. The epidemiological studies on JIA are based on the distribution of the disease and the subgroup characteristics varying in different ethnic groups and socioeconomic levels. The laboratory markers, specifically Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP), are not specific and are influenced by several other variables. There are several important dis-advantages to the use of CRP and ESR as a marker of JIA, including changes in serum con¬centrations associated with age and sex and the existence of co-morbid infection. In addition to routine clinical investigations, there are other biomarkers such as endothelial progenitor cells (EPCs) (CD34+ and CD309+). Therefore, the current study aimed to assess the value of endothelial progenitor cells (EPCs) and assess carotid Doppler ultrasound in patients with JIA. Participants and Methods: The current study recruited 41 children and adolescents diagnosed with juvenile idiopathic arthritis (JIA) (According to International League of Associations for Rheumatism criteria) for at least one year. Patients were recruited from the outpatient clinic of rheumatology and rehabilitation clinic at MUCH during their routine visits. This study was approved by local institutional research board (IRP) of faculty of medicine Mansoura University. The study was explained to all participants and an informed consent was obtained from each participant/parent before enrolled in the study. All patients underwent a thorough clinical examination. Assessment of JIA patients involved assessment of disease activity, tenderness and functional assessment. Laboratory tests were done for all JIA children including: CBC, ESR, CRP, creatinine levels and CD34+ CD309+ cells and carotid Doppler u.s. Results The age and sex of the JIA patients are shown in the current study; the mean age was 10.4 ±3.5 years with range between 4 and 16 years. Among the cases included, 27 cases were females (65.9%) and 14 were males (34.1%). When the cases were classified according to clinical findings in the first six months, the largest group consisted of 33 patients (80.5%) with polyarticular JIA, 19.5% of them were RF(-) and 61% were RF(+) patients. Eight IJA patients (19.5%) classified as oligoarticular subtype. In JIA patients, the disease duration ranged from 1 to 10 years with a mean (±SD) of 3.6±2.6 years. The most common joint presenting in JIA patients was found to be tender joint count, swollen joint count, and JADAS-27 joint count. The mean tender joint count was (1.7±1.4) ranged between 0 and 5. The mean swollen joint count was (3.1±2.1) ranged between 0 and 8. As regard, the mean JADAS-27 joint count was (11.3 ±9.1) with wide range between 2 and 33. Regarding the analysis of the presenting symptoms, fever was present in 14 cases (34.1%), pallor was present in 10 cases (24.4%), uveitis and dyspnea were present in 6 cases (14.6%) each, morning stiffness was the most detected symptom found it was found in 28 cases (68.3%) and fatigue was present in 10 cases (24.4%). ESR in JIA patients showed a minimum value of 9 mm and a maximum value of 120 mm in the first hour with a mean (±SD) 47.0 ±28.2 in the first hour. The mean serum creatinine level was (0.50 ±0.22 mg/dL) with range between 0.2 and 0.9 mg/dL. The mean RBCs count was (4.2 ±1.0 ×106 cells/mm3) with range between 1.2 and 6.6 ×106 cells/mm3, the mean WBCs count was (10.7 ±2.0 ×106 cells/mm3) with range between 4.2 and 15.2 ×103 cells/mm3; and the mean platelets count was (308.2±59.5 ×103 cells/mm3) with range between 224 and 497 ×103 cells/mm3. However, the mean Hb concentration was (11.6±1.5 mg/dL) with range between 8.8 and 13.6 mg/dL. Moreover, CRP was +ve in 9 (22%), -ve in 32 (78%) in our patients. The mean level of CD34+ level of the cases was (0.44±0.43), the median level was 0.4 with range between 0.10 – 2.60. The mean level of CD309+ level of the cases was (0.43±0.37), the median level was 0.3 with range between 0.10 – 2.40. which considered low level without significant value. The mean carotid intima-media thickness (IMT) left side of the cases was (0.52±0.05) with range between 0.10 – 070. The mean IMT right side of the cases was (0.43±0.07) with range between 0.20 – 060. There was moderate positive statistically significant correlation between CD34+ and CD 309+ (r= 0.408 and p= 0.008). On the other hand, there was no significant correlation between CD34+ and age, clinical or laboratory findings of the study group. There was moderate positive significant correlation between CD309+ with CD34+ (r= 0.408 and p= 0.008), age (r= 0.341 and p= 0.029) and RBCs count (r= 0.367 and p= 0.018). On the other hand, there was no significant correlation between CD309+ and other clinical or laboratory findings of the study group. There was high statistically significant strong positive correlation between left IMT with right IMT (r= 0.797 and p< 0.001). On the other hand, there was no significant correlation between left or right IMT side and age, and clinical and laboratory findings between the study group. There was no significant association of CD34+ in sex, clinical symptoms and CRP concentration among females and males JIA patients. The median level of CD309+ in females was 0.30 and in males it was 0.4. Statistically, there was significant association of CD309+ among males than females in JIA patients (p = 0.015). But there was no significant association of CD309+ in clinical findings and CRP concentration among JIA patients. Conclusion from this study we concluded that: There was moderate positive significant correlation between CD309+ with CD34+ among ages and RBCs There was high statistically significant strong positive correlation between right and left carotid IMT; but, there was no significant positive correlation between right or left carotid IMT with age, duration of the disease, ESR, RBCs count, platelets count, CD34+ and CD309+. The level of CD309+ cells was significantly higher in males than females in JIA patients. The level of CD34+ CD309+ had no statistically significant difference when correlated to clinical features in JIA children. Recommendations We recommend more studies focusing on the advantage of EPCs over other disease activity parameters and its role in development of premature atherosclerosis in JIA children. We recommend future studies concentrating on EPCs among diseases subtypes in JIA.