الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Rheumatoid arthritis is a chronic systemic autoimmune inflammatory disease that affect all ethnic groups more in females with a prevalence of 1-2%. It is the result of genetic and environmental factors interaction. The pathogenesis includes interconnected cellular molecular pathways leading to destruction of cartilage and bone.
The clinical manifestation include articular manifestations with different patterns of joint involvement, the most common of which is symmetrical polyarthritis that affects early small joints of the hands and feet. Extra articular manifestations include hematologic, renal, cutaneous, vascular, pulmonary and neurological involvement.
RA diagnosis is based on the 2010 ACR/EULAR classification criteria that depend on clinical arthritis, duration of symptoms, serology and acute phase reactants. Continuous assessment of disease activity and severity is essential to achieve remission as a treatment target to prevent long term disability. Assessment involves clinical, laboratory and imaging parameters.
Vitamin D is a steroid hormone that is synthesized in the skin from 7-dehydrocholesterol under the effect of sunlight as well as intake from the diet. It plays an essential function in maintaining a proper level of serum calcium and phosphorus. Without vitamin D, only about 10 to 15% of dietary calcium and about 60% of phosphorus is absorbed. Also, vitamin D has been used in managing minor abnormalities so as to improve quality of life, that in addition to its role in treating and preventing multiple diseases.
It is proved that vitamin D enhances immunologic tolerance. Vitamin D deficiency may also impair immune tolerance and trigger autoimmune disorders, such as RA, to develop. Vitamin D has immunomodulatory properties, acting both in an endocrine and in a paracrine manner on the immune system. It suppresses proliferation and immunoglobulin production and inhibits differentiation of B-cell precursors into plasma cells.
Research has shown that Vitamin D plays an important role in the etiology and maintenance of chronic pain states and associated comorbidity.
The aim of this study is to assess serum vitamin D levels in patients suffering (RA) and to correlate the values with functional disability and neuropathic pain.
The present study was conducted on 30 females patients with RA and 30 healthy control subjects. The patients were diagnosed according to the 2010 ACR-EULAR classification criteria for RA with exclusion of patients having any systemic disease that may be combined with neuropathy as diabetes, hypothyroidism, chronic kidney failure, liver disease, any metabolic bone disease such as hyperparathyroidism, hyperthyroidism and patients who use any medication which can affect the level of vitamin D or NP (psychiatric medications such as antidepressants, anxiolytics or sleeping pills).