الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease (AID) affecting the joints. It is featured by a progressive synovial inflammation which ultimately ends in cartilage damage, bony erosions, and disability. RA could affect a lot of joints especially the joints of the hands, wrists, and feet. In addition, inflammation could interfere with different tissue which include the skin, lungs, and the myocardium. As a result, precise evaluation of RA activity is of great importance in order to make early therapeutic decisions. A lot of indices are utilized to evaluate RA activity according to the clinical presentation, laboratory, and physical measurements. Clinically, DAS 28, and simplified disease activity index (SDAI) could be utilized to evaluate RA activity. On the other hand, DAS28-ESR criteria have a lot of drawbacks as many cases in DAS28-ESR relapse could still have minimal degrees of RA activity. Among adipokines chemerin has been considered as a special pro-resolving protein mediator which contribute to the initial inflammatory phase and participate in the initiations of the pro-resolving responses. Chemerin is 14 kDa protein that activates chemotaxis of dendritic cells and macrophages to the inflammatory area. In addition, it triggers maturation and differentiation of pre-adipocytes, and play a major role in the context of innate and acquired immunity. In addition, the chemerin 15 has anti-inflammatory actions, and could be included in the process of inflammatory resolution. Chemerin suppresses formation of proinflammatory TNF-α and IL-6, and as a result could induce protective effects. Of note, pro-inflammatory or anti-inflammatory peptides could compete for ChemR23 and induce contrasting actions. Nowadays the usage of musculoskeletal ultrasound (MSUS) is a corner stone in RA as it’s available, more practical, and less costly. It helps in the detection and monitoring of the disease. EULAR recommendations highlight that the use of MSUS is superior to clinical examination to detect inflammation. Power Doppler (PD) has the ability to recognize active inflammation and neo-angiogenesis. The two parameters are of great importance as regards the follow-up of RA cases. Additionally, it has been considered as a reliable indicator in the context of the determination of bony erosions, subclinical synovitis, and prediction of recurrence. Thus, the aim of our work was to estimate the accuracy of serum chemerin levels as a biomarker of RA disease activity, correlates its level with ultrasonographic finding. As US recently can be used as a confirmatory and mandatory tool for disease activity in RA patients. The study included 44 successive RA cases diagnosed based on the ACR/EULAR 2010 criteria & included 44 age and sex matched apparently healthy volunteers who were selected randomly and invited to contribute to the study as controls. Written informed consent was obtained from all participants after assuring confidentiality. Subjects with any of the following were rule out from the study: Patients who had various types of arthritis including connective tissue diseases, septic arthritis and any other autoimmune disorders like overlap syndromes, psoriatic arthritis, and reactive arthritis, patients with malignancy, chronic kidney, coronary diseases and liver diseases, lactation, pregnancy, patients with thyroid diseases, a blood transfusion in the preceding three months, and any subject in control group with family history of RA. In the current study, no statistically significant association between chemerin serum levels and sociodemographic findings of RA patients was observed. Regarding sex, our results illustrate non statistically significant difference of median chemerin between males and females (p=0.452). Our data show that chemerin plasma values positively correlate with BMI in RA patients at diagnosis with mean body mass index ranging from 18.7 to 39.4 kg/m. In our study the results of correlation between ESR & CRP and chemerin among studied patients shows significant association between chemerin and ESR (p<0.001) and CRP (p= 0.031). Regarding Anti-CCP and RF our results showed that there is no significant association between chemerin levels and positivity of RF (p=0.408) or Anti-CCP(p=0.523). Our results showed that chemerin levels in active group illustrate that are under curve for chemerin in differentiating patients from control group is 0.892 with the best detected cut off point is 323.93 yielding sensitivity of 81.8%, specificity 88.6% and total accuracy of 85.2%. In our study, we heavily focused on the relationship between serum chemerin and ultrasonographic markers. Strong evidence of serum chemerin not only significantly correlated with RA activity but also strongly correlated with MSUS and PD MSUS. The results show that chemerin was significantly correlated with synovitis GS (P= 0.011), synovitis PD (p<0.001), tenosynovitis GS (p= 0.05), tenosynovitis PD (p=0.05), and erosions score (p= 0.05).