Keywords : Rheumatoid Arthritis

Effect of Hand Deformities on Hand Function in a Sample of Patients with Rheumatoid Arthritis

Mohammed S. Al-Omran; Khudair Z. Al-Bidri

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 2, Pages 288-295

Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disease that commonly affects the small joints of the hands and feet, and results in irreversible joint damage, deformity, and functional impairment.
Hand function is an important domain of the health status of RA patients. Assessment of hand function, therefore, is an essential part in the follow-up of RA patients and in gauging their response to treatment.
Numerous measures were developed to evaluate the hand function. One widely accepted measure includes simple clinical tests: Key grip, ball grasp, pen grasp, pinch grip and grip strength.
This study aims to determine the effect of hand deformities on hand function in a sample of patients with RA.
A cross-sectional study was conducted on 116 randomly selected patients fulfilling the 2010 ACR/EULAR criteria for Classification of RA. Patients with other conditions that can affect the hand function were excluded.
Patients were evaluated for age, hand deformities and Disease Activity Index (DAS28). A novel score was used to combine all hand deformities into one value.
Hand function was assessed by 3 subjective tests (key grip, pen grasp and ball grasp) and 2 objective tests (pinch strength and grip strength, measured by specialized dynamometers).
Objective hand function tests (mean grip strength and mean pinch strength) had significant moderate negative correlations with the score of hand deformities (p<0.001, r=-0.459 or better), while the mean ranks of impairment of subjective hand function tests (key grip, pen grasp and ball grasp) showed significant weak positive correlations with the score of hand deformities (p=0.002 or less, r=0.283 or more).
The presence and degree of hand deformities are significantly associated with poor hand function in patients with rheumatoid arthritis.
KEYWORDS: rheumatoid arthritis, hand deformities, hand function.

Frequency of Anti Lactoferrin Antibodies in Patients With Systemic Lupus Erythematosus and Rheumatoid Arthriti

Nahla Ghanim Abdul; Majeed; Mahmood Raheem Al-Rubaye; Najeha Ahmed Ameen; leen Khalooq Mustafa Kamil

Iraqi Postgraduate Medical Journal, 2014, Volume 13, Issue 4, Pages 571-577

Lactoferrin is a multifunctional iron-binding protein present in several mucosal secretions as well as in secondary granules of polymorphonuclear leukocytes.Anti-Lactoferrin antibodies, which belong to antineutrophil cytoplasmic antibodies have been described in several immunomediated diseases, including Systemic Lupus Erythematosus and in patients with Rheumatoid Arthritis and others, with conflicting results regarding either their prevalence or clinical associations.
Detection of anti-Lactoferrin antibodies in Systemic Lupus Erythematosis and Rheumatoid Arthritis patients and studying its association to disease activity in comparison to healthy controls.
The study involved 74 Systemic Lupus Erythematosis patients, 40 Rheumatoid Arthritis patients who were referred to Immunological Department in Teaching laboratory Medical City during period of (1st of January – 31st of June) 2011 and 30 apparently healthy individual. Antinuclear antibody, complement C1q, rheumatoid factor and lactoferrin antibody were detected by enzyme-linked immunosorbent assay technique While double stranded DNA was detected by indirect immunofluorescent technique and complements (C3, C4) by single radial immune diffusion.
Anti-lactoferrin Ab was detected in 14(18.9%) SLE patients, 4 (8.9%) Rheumatoid arthritis patients. Both C3&C4 levels were decreased significantly in Systemic lupus with positive anti lactoferrin Ab level in comparison to healthy controls( p value 0.024). In this regard Circulating immune complex was positive in 38(51.3%) systemic lupus patients only 12(31.5%) had positive lactoferrin antibody level, (p value 0.004).double stranded DNA was detected in 41(55.4%) Systemic lupus patients only 7(17.0%) of them had positive lactoferrin Ab level. Anti -Lactoferrin Abs showed neither a significant correlation with Rheumatoid factor IgG& IgM ( P value 0.159 ) nor with rheumatoid factor IgA ( P value 0. 857).
Anti-lactoferrin antibodies could be detected in patients with Rheumatoid Arthritis and more often in patients with Systemic Lupus with significant correlation to decrease complements levels in comparison to healthy control.

Incdence of Rheumatoid Arthritis [2001 to 2011]

Ali Mohammed Hussein Alkazzaz

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 4, Pages 568-572

The incidence of rheumatoid arthritis[RA] varies from country to another which not depend on genetic bases alone but can explained by environmental exposure and genetic and environmental interaction, area of military conflict ,there was stress induced pathway that elevates the risk for rheumatoid arthritis, in Iraq rheumatoid was 1% of population in 1975.
To evaluate incidence of RA in Babylon –Iraq from 2001-2011
This study was done to examine the incidence of RA in Babylon between 2001-2011 by Retrospective cohort study in Merjan Teaching Hospital ,Rheumatology unit .Data included sex .birth year ,residency and latex test , from 2001 to 2011.All patients were diagnosed as Rheumatoid Arthritis according to American College of Rheumatology ACR 1987revised criteria of RA .the numbers of patients of RA who were received DMRADs included methotrxate therapy were recorded each year and incidence of each year was found then the cumulative incidence was calculated.
There were1039 patients with rheumatoid arthritis from 53786 patients in rheumatology unit. 50.1% living in urban area while 49.9% in rural area. The incidence in 2001 was 1.60 while in 2011 was 3.02 for the same population and the cumulative incidence in 2011 was22.74. Latex test was 52% in2001 while in2011 was 58% in rheumatoid patients in the same year. The P value for age mean difference between female and male was [0.009].
The incidence of RA was increasing from 1.60% in 2001 to 3.02% in 2011 and the cumulative risk wasb22.74% in Babylon –Iraq.
KEY WARDS: rheumatoid arthritis.

Effect of Methotrexate on Serum Levels of IL-1α and IL-8 in Rheumatoid Arthritis

Ahmed A. Al-Hassan; Mohammed O. Hamzah; Batool H. Al-Ghurabei

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 3, Pages 404-408


Pathogenetic therapy of RA is a complex task,
according to modern views on the development of

* Dept. of Microbiology, Medical College, Al-
Nahrain Univ.
** Dept. of Clinical Biochemistry, Medical
College, Al-Nahrain Univ.
*** Dept of Basic Science, College of Dentistry,
Univ. of Baghdad.


autoimmune inflammation in RA, cytokine
imbalance plays a great part in RA pathogenesis
Rheumatoid arthritis is a chronic systemic inflammatory disease affects many tissues and organs, but
principally attacks flexible (synovial) joints. Methotrexate is the most commonly used disease-modifying
antirheumatic drug for the treatment of rheumatoid arthritis.
The aim of this study was to evaluate the effect of methotrexate on serum levels of IL-1α and IL-8 in
rheumatoid arthritis.
Blood samples were collected from 50 patients with rheumatoid arthritis (25 patients without treatment
and 25 patients are received methotraxate) and from 30 healthy age and sex matched individuals served as
controls. Serum IL-1α and IL-8 were measured by means of enzyme-linked immune-sorbent assay.
The present results showed that serum levels of IL-1α and IL-8 were significantly higher in RA patients
than in healthy controls (P<0.01), furthermore, level of IL-1α was significantly decrease in patients
treated with methotraxate as compared to those patients who have received no treatment (P<0. 01). On the
other hand serum level of IL-8 did not showed any significant differences between patients treated with
methotraxate and those patients without treatment (P>0. 05).
These finding demonstrate that methotrexate turns out to be a good inhibitor for IL-α production. In
addition, IL-1α and IL-8 may have a significant role in the pathogenesis of rheumatoid arthritis, and could
be use a

The Association of Smoking with the Extra-Articular Manifestations in Rheumatoid Arthritis Patients

Mohammed Hadi Al-Osami; Ali Abdul Majid Allawi; Tahir Hussein Al-Saadawi

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 1, Pages 146-152

Rheumatoid Arthritis (RA) is a chronic systemic autoimmune inflammatory disease that affect all ethnic groups throughout the world, the main characteristic symptom is persistent synovitis of diarthroidal joints often symmetrical resulting in pain, stiffness, and limitation of movement. Smoking is the most established environmental risk factor for development, severity,and extra-articular manifestation of RA..
To assess the association between smoking and appearance of extra-articular manifestation.
A cross sectional study was conducted on 244 patients with RA meeting the American College of Rheumatology Criteria for the classification of RA. Patients data were obtained via face - to- face interview performed by rheumatologist. RA disease-related data, such as disease duration, drug use (all anti-rheumatic drugs , glucocorticoid use and NSAID's), history of smoking which is classified into current smoker, former Smoker ( patient discontinue smoking for at least three months ), and never smoker , also number of cigarette per day were also recorded.Extra-articular manifestation of RA were assessed in all patient by thorough physical examination, and the patient send for appropriate investigation to confirm the diagnosis.
Among 244 patients with RA, 76.2% were women and 23.8% were men, the females were significantly predominate the study samples (P<0.001). The mean (SD) age are 46.9 ± 11.4, the age varies with smoking history (P=0.043). It is significant to find that two third of patients (69.3%) not have smoking history (P<0.001) because majority of patients were female.Smoking is significantly increase rheumatoid factor positivity (P=0.013), Smoking is significantly associated with rheumatoid nodules (P<0.001), secondary Sjögren syndrome (P<0.001), and eye involvement (P=0.002), while there is no significant association with other extra-articular manifestations..
There is significant association between smoking and RA extra-articular manifestations

Serum Anti-Cyclic Citrullinated Peptide (Anti_CCP) Antibody Level in Rheumatoid Arthritic Patients with and without Nodal Osteoarthritis

Ahmed A. Gassid

Iraqi Postgraduate Medical Journal, 2012, Volume 11, Issue 2, Pages 151-156

Rheumatoid Arthritis (RA) is chronic systemic inflammatory disease affects synovial joints , articular structures and extra articular , the prevalence rate occurs aprox in about 1% of population Anti citrullinated peptide/protein antibody (Anti-CCP) antibody are autoantibodies(antibodies directed against one or more of the individuals own proteins) frequently detected in RA patients during inflammation. citrulline is incorporated enzymatically into proteins .
The current study is a trail to ensure that Anti-CCP marker is more specific and sensitive for diagnosis of RA patients and to detect the effect of the presence of other disease like NOA on Anti-CCP value
Evaluation of Anti-CCP Ab level in RA patients with and without NOA.The serum level of Accp_Ab is estimated using ELISA technique in patients with RA and NOA.
The studied group includes 30 RA patients (24 females and 6 males), who fulfilled four or more of the 1987 ACR criteria compared with 30 RA+NOA patients (23 females and 7 males) also fulfilled four or more of the 1987 ACR criteria for the classification of Rheumatoid arthritis and nodal osteoarthritis group. Blood samples were taken from three groups to analyze and measure the serum levels of Anti-CCP.
Result of investigations were compared with that for the 30 apparently healthy control individuals who matched the patient´s group in age and sex.
The result of the study showed that majority of patients is females (80%) for RA patients and (76.6%) for RA+NOA patients (with females: males 4:1 & 3.28:1 for RA and RA+NOA respectively). Moreover, the mean age for RA, RA+NOA and control groups are: 48.03±12.95y, 51.3±11.8y and 37.43±12.57years respectively.
It was observed from the result that there is a higher positivity of Anti-CCP in the patients sera( 76.7% for RA+NOA cases and 70% for RA cases) in comparison with healthy control group (0.0%) so there is highly significant difference (p<0.001).
While the quantitative estimation of Anti-CCP antibodies showed that its level was higher among sera of RA+NOA patients in addition to RA patients (53.59±33.29 RU/ml and 52.28±48.99 RU/ml respectively) in comparison with healthy control group 2.88±2.50 RU/ml.
We found that Anti-CCP is a good & specific marker for diagnosis of RA & RA can be differentiated from other disease by measuring this marker.
Moreover, Anti-CCP Ab level in RA patients does not significantly affected by the presence of NOA.

The Role of IL-1 and Tumor Necrosis Factor-α in Pathogenesis of Rheumatoid Arthritis

Eman Sh.Al-Obeidy; Shatha F. Abdullah

Iraqi Postgraduate Medical Journal, 2011, Volume 10, Issue 2, Pages 161-165

Rheumatoid Arthritis (RA) is a common chronic inflammatory and destructive arthropathy that cannot be cured.Interlukin-1 (IL-1), IL-6 and tumor necrosis factor (TNF- α) are the key cytokines that drive inflammation in the disease.
The study was established to shed light on the possible role of IL-1 and TNF- α in pathogenesis of RA.
Rheumatoid Factors (RF),TNF-α and IL-1 were detected by Enzyme-Linked Immunosorbent Assay (ELISA) .C-reactive protein(CRP) on the other hand has been detected by using latex agglutination kit in the serum of 50 Iraqi patients with RA in comparison with 50 healthy individuals.
Significant high levels of IL-1and TNF- α were observed in RA patients sera with P-value ( 0.04 and 0.001) respectively compared to healthy control group, in addition a positive linear association was found between the concentration of IL-1and TNF- α and CRP with P-value ( 0.05 and 0.001) respectively.
IL-1and TNF- α play a role in pathogenesis of RA

Hormonal and Immunological Disturbances in Patients with Rheumatoid Arthritis and Systemic Lupus Erythematosus

Numman Hamed. Salih

Iraqi Postgraduate Medical Journal, 2008, Volume 7, Issue 1, Pages 65-70

Rheumatoid arthritis and systemic lupus erythematosus are multifactorial autoimmune diseases.
Some recent reports indicated a hormonal disturbances affected the balance between Th1 and Th2
lymphocyte response.
To investigate the immunological and hormonal disturbance in patient with rheumatoid arthritis
(RA) and systemic lupus erythematosus (SLE).
Serum samples, were collected from patients with RA, SLE and control, then the tests for
antinuclear antibodies, anti double strand DNA, anticardiolipin antibodies are done by using
Enzyme linked immuno assay (ELISA) method. Also, hormonal studies including estrogen,
progesterone and prolactin level are done by using the Radio immunoassay technique (RIA).
The results indicated the increasing of ANA, anti ds-DNA, and anticardiolipin antibodies. Also,
elevation in the levels of estrogen, progesterone and prolactin in patients with RA and SLE
comparing with control.
Immunological and hormonal disturbances in patients with RA and SLE were documented through
through the increasing of ANA, anti dsDNA anticardiolipin antibodies and elevation of the level of
estrogen, progesterone, and prolactin.