الفهرس 
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Abstract
Rheumatoid arthritis is a chronic systemic disabling auto immune inflammatory arthritis associated with progressive joint destructions account for the disabilities and increased mortality. Although the exact cause is still unknown, the investigations of its pathogenesis has demonstrated the role of many pro-inflammatory cytokines including IL1,IL6.In RA, certain markers may be present as a consequence of the disease and others may be linked to the disease pathogenesis. Therefore, identifying patients with aggressive early RA for prompt and appropriate treatment is critical to minimize irreversible joint destruction and disability. RA remains a burdensome condition, as it is usually diagnosed at a late stage and patients typically exhibit symptoms for the remainder of their life. Prediction of the disease seriousness always done by clinical assessment, imaging modalities, and the measuring of auto-antibodies and other serological biomarkers. With the high diagnostic value of ACPAs and rheumatoid factors (RFs), there is still a need for novel biomarkers to further improve the diagnosis of RA. Several novel autoantigens and antibodies that may enhance early diagnosis and prediction of the disease development have been recently identified. The protein 14-3-3η is a member of a family of highly conserved intracellular proteins. Belong to a family of seven isoforms known to bind to and regulate the biologic activity of various intracellular proteins. They are found in all eukaryotic species and encoded by genes that are located on different chromosomes 14-3-3η may play an essential role in the pathogenesis of autoimmune diseases. Also, 14- 3-3η auto-antibodies were detected in ankylosing spondylitis patients at significant higher level than healthy controls .The presence of either 14-3-3η or its auto-antibodies was detected in 90% of early RA patient. Serum 14-3-3η is a novel protein biomarker showing potential in predicting radiographic deterioration in early and advanced RA. Overexpression of 14-3-3 proteins is associated with worse outcomes in various diseases, such as cancers, neurodegenerative diseases. The 14-3-3η isoform is expressed at higher levels in patients with arthritis compared with healthy individuals, which is thought to be related to 14-3-3η’s direct ability to induce factors linked to inflammation and radiographic damage. 14-3-3η has been shown to induce inflammatory factors such as interleukin IL 1 and 6, and is linked to the process of joint damage as it also induces factors such as receptor activator of nuclear factorkB ligand (RANKL) and matrix metalloproteinase (MMP). The aim of this study was to assess the level of serum 14-3-3η protein in early and established RA patients and its correlation with disease activity. The study include 50 patients diagnosed as rheumatoid arthritis classification criteria for rheumatoid arthritis according to ACR/EULAR 2010 and 25 apparently healthy individuals as control group at The Department of Rheumatology and Rehabilitation and Physical medicine Tanta University Hospitals. Patients were classified into two groups: • group (A) 25 patients with early RA within the first 2 years of the disease • group (B) 25 patients with established RA And 25 apparently healthy individuals as control group (C) All rheumatoid arthritis patients were subjected to the following: 1. History taking 2. Clinical examination. 3. The following laboratory investigations was done: -ESR -RF -CRP -ACPA -serum 14-3-3 protein. 4. Pain is assessed by global visual analogue scale (VAS). 5. Measurement of disease activity by Disease Activity Score (DAS28). 6. Patient functional assessment by Modified Health Assessment Questionnaire (MHAQ) 7. Radiographic assessment by Sharp/van der heijde Score (SHS) by (SENSE) method. The result could be summarized as follow: There was high significance difference between the three studied groups As regard to serum 14-3-3 eta ptn, There was significant difference between the group early and control groups to serum 14-3-3 eta protein ,also there was significance difference between establshid and control groups while there was no significance difference between group early and established RA patient according to the serum 14-3-3 eta protein. There was a positive correlation between serum 14-3-3 eta ptn and DAS 28 in both groups A&B .also there was a positive correlation between numbers of tender joints with serum 14- 3-3 eta ptn in the two studied groups , and also between number of swollen joints . There was a positive correlation between MHAQ & serum 14-3-3 eta ptn in the two studied groups. Also as regard to VAS there was positive correlation with serum 14-3-3 eta ptn in both groups A&B. There was a positive correlation between serum 14-3-3η ptn and the radiological score in the two studied groups early and established RA.