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Abstract Ankylosing spondylitis (AS) is a systemic chronic inflammatory autoimmune rheumatic disease characterized mainly by involvement of sacroiliac joints and axial skeleton, showing a strong genetic predisposition with an unknown etiology. In addition to inflammatory low back pain with or without peripheral arthritis, extra-articular manifestations including anterior uveitis, aortic valve insufficiency, cardiac conduction disorders, apical lung fibrosis, or secondary amyloidosis may also be seen. Aim Of The Work The aim of this work was to evaluate thyroid functions and thyroid autoantibodies in ankylosing spondylitis patients on anti-TNF-alpha and its relation to disease activity. Patients and Methods All patients diagnosed as ankylosing spondylitis (AS) according to ASAS classification criteria. Patients were recruited from Physical Medicine, Rheumatology and Rehabilitation Outpatient Clinic in Al- Menoufia University Hospitals and collected over a period of 6 months. Patients were classified into two groups all diagnosed as of ankylosing spondylitis: group I: Patients treated with non-steroidal anti-inflammatory drugs (NSAIDs). group II: Patients treated with anti-TNF-. All patients were subjected to history taking, complete clinical examination to assess the lumbosacral, sacroilial and peripheral joints; as well as assissing the disease activity, functional disease activity and spinal mobility. 97 Summary Investigations used to help in diagnosis were complete blood picture; erythrocyte sedimentation rate; c-reactive protein titer; thyroid functions tests; anti-thyroid peroxidase antibody titers; HLA-B27 as well as neck ulsonography to assess the thyroid gland. Results The results of our study revealed that there was a significant difference between both groups regarding disease duration (P = 0.01). In NSAIDs group, all patients (76.7%) were male smokers while (23.3%) were non-smokers. In anti-TNF- group, (53.3%) were smokers while (46.7%) were non-smokers {P = 0.007, (Table 4, Fig. 9)}. Also, There was a significant difference between both groups regarding disease duration (P = 0.01). Also, there was significant difference regarding BASDI (P = 0.005), BASMI (P = 0.000) and BASFI (P = 0.013). Our results revealed that laboratory investigation revealed a significant reduction in the mean value of CRP, TSH, Anti-TPO, HLA-B27 and significant reduction in the percentage of positivity of HLA-B27 in anti-TNF- group than in NSAIDs group {P = 0.005, 0.001, 0.00, 0.002 and 0.007 respectively, (Table 8, Fig. 11)}. While there was no significant difference between both groups regarding ESR, FT3 and FT4 (P = 0.223, 0.257, 0.531) respectively. from this study we can conclude that thyroid autoimmune disease presented in a good proportion with ankylosing spondylitis and treatment with anti-TNF- helps to control the immunogenecity of ankylosing spondylitis and lower the incidence of occurrence of thyroid disorders with that disease. So, we recommend the use of anti-TNF- agents in management of ankylosing spondylitis for its beneficial effect in controlling immunogenecity of this disease and to help in lowering the incidence of occurrence of thyroid disorders with that disease. |