الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
All patients were subjected to full history taking, thorough clinical examination, laboratory investigation, radiological assessment, assessment of disease activity and severity in RA patients and in RA-ILD patients by standard functional and radiological scores. Patients with other autoimmune illnesses such as SSCs and PM/DM were excluded from the study.
HSP90a in our study show high significant difference between RA patients with and without subclinical ILD and IPF patients, also it was high in RA-ILD when compared with IPF patients but not reach statistically significance which reveals a high specificity of HSP90a in RA patients especially with ILD.
ACPA in RA patients without subclinical ILD in our study when compared to RA patients with subclinical ILD and RA patients with ILD showed a high significant difference between groups, which insure the importance of ACPA as a risk and predictor factor to ILD in RA patients and a high positivity of it in RA-ILD patients. The same significant found as regard RF when assessed in RA patients with subclinical ILD and RA patients with ILD in comparasion to IPF patients.
When we assessed the activity and functional assessment of articular manifestation, we found a significant difference in DAS 28 activity index and HAQ disability index between RA patients without subclinical ILD (Ia) and RA patients with ILD (II), indicating high disease activity in the RA-ILD group.
RA patients with ILD and IPF group in our study were worse parameters of pulmonary function tests in form of substantial DROP in FVC, TLC and considerable DROP in DLCO when compared to other groups
In addition, when comparing RA patients with preclinical ILD to RA patients only, there was a large statistically significant difference in DLCO, indicating that DLCO is a sensitive metric in RA patients with subclinical ILD.
When comparing RA patients with subclinical ILD to RA patients with ILD and IPF patients, we found a high significant difference between the groups in terms of different ILD patterns. This was especially true for the NSIP pattern, which was more prominent in RA patients with subclinical ILD. In comparison to RA patients with subclinical ILD, the UIP pattern was more visible in RA patients with ILD, IPF patients.
We noticed that ACAPA in RA-ILD patients was significantly correlated with HAQ disability index and Kazarooni fibrosis score in this study, implying that ACAPA links with the severity of articular and lung affection in RA patients.
In our study, FVC was found to be inversely correlated with ACPA and Kazarooni fibrosis score, also strongly correlated with ESR and HSP90a in RA-ILD patients, indicating that pulmonary function testing should be used in the follow-up of these patients as a less invasive and less expensive method.
Our findings also revealed a link between DLCO, CRP, and the Kazarooni GGO score. As a result, these metrics can be used to evaluate lung activity in RA-ILD patients.