الفهرس 
RHEUMATOID ARTHRITISOnly 14 pages are availabe for public view
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Abstract
Rheumatoid arthritis (RA) is one of the most common autoimmune diseases of connective tissue and is considered as a rheumatic disease. Women, especially in the third to the fifth decades of life, are affected by RA 3 times more than men (Amini et al., 2018)
And because most of these women are in the reproductive age and they have to be on a teratogenic drugs for a long periods, so there is a big need to clarify the contraceptive method that should be used by women with rheumatic diseases and other than the use of contraceptives carry risks or not on the RA activity and severity (Katherine et al., 2020).
Therefore, the objective of this study is to explore the association of the RA activity and the commonly used female contraceptive methods in Egypt. We aim to fill in the gaps in knowledge about the insights in choices of the best contraceptive methods (that can be used by the female RA patients) which can improve activity score of the disease or at least does not cause further deterioration.
Fifty RA female patients were enrolled and divided into two groups; contraception users (40 patients), who was further subdivided into 15 patients who are IUD users, 13 oral contraceptives users and 12 injectables users, and non-contraception users (10 patients).
The study was performed among female patients with rheumatoid arthritis seeking health care service at the outpatient clinic of Physical medicine, Rheumatology and Rehabilitation department.
Their age ranged between (26-50) years, the injectable users group has the lower educational level in comparison to the other groups, the body mass index (BMI) ranged between (18-35), and menarche age ranged from (9-16) years with no statistical difference between the four groups.
On clinical assessment, the swollen joint count and morning stiffness showed no statistical significance between the four groups, while the highest tender joint count was in the IUD (P value 0.018).
On comparing the disease activity DAS28/CRP of RA patients among the four different groups.the highest score was found in the IUD users, followed by the injectables users, then the control group, then the OCs users (P value 0.004).
As for the severity of RA by RASS among the four groups, the highest score was found among the injectable users followed by the IUD users then the control and the OC users (P value 0.002).
Regarding comorbidities associated with RA (diabetes mellitus, hypertension, interstitial lung disease and hypothyroidism) there was non-statistically significant difference between the four groups.
Common expressed clinical extra articular manifestations by the studied patients were subcutaneous nodules, fever, weight loss, thromboembolic manifestations and sicca manifestations, there was no statistical significance between the four groups
As regarding DMARD used by patients, 76 % of them were using Methotrexate,38 % on Sulfasalazine, 30% on leflunomide and 56 % on hydroxychloroquine, corticosteroid was used by 90% of the patients.
Within the studied groups, 92.3 % of the OC users were compliant on their treatment representing the most compliant group, followed by the non-users (80%) then the IUD users (66.7%). The least compliant group was the injectables users (50 %)
As for laboratory data, OC users had the highest total leucocytic count (TLC) in comparison to other groups in overall (P value 0.003). However the highest erythrocyte sedimentation rate (ESR) level was found in injectables followed by IUD users then the control group and OC users group(P value 0.016).Otherwise, there were no statistically significant differences in other laboratory parameters.
As regarding Rheumatoid factor(RF) there was no statistical difference between the four groups, while we found the highest C-reactive protein (CRP) level in the IUD users group followed by the injectable users, then the control group then OC users (P value 0.038).Also, the highest anticitrullinated peptide antibody (ACPA) titre was found in the IUD users group followed by the injectable users, then the control group then OC users (P value0.005).