الفهرس 
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Abstract
This case-control study included 60 RA patients, selected from 120 RA patients attending the Rheumatology clinic in Assuit university hospital. Patients were diagnosed as RA according to ACR/EULAR 2010criteria (Aletaha et al., 2010).Twenty apparently healthy subjects were taken as a control. Patients were classified into two groups: - sero positive ACPA patients(No:30). - sero negative ACPA patients(No:30). All subjects were informed about the aim of the study and gave their written consent. This study is done on attempt of finding serological marker to improve early diagnosis and treatment of the patients or even narrowing the serological gap in RA diagnosis. The following were done (for patients and control group): 1-Medical history and clinical examination .Complete history takingand clinical examination. 2-Laboratory investigations: The following investigations we performed: 1- Complete blood count (CBC). 2- Erythrocyte sedimentation rate (ESR). 3- Serum glucose, urea, creatinine , uric acid and liver function tests. 4- C-reactive protein (CRP). 5- Rheumatoid factor (RF). 6- Anti cyclic citrullinated peptide antibodies (Anti-CCP). 7- Serum anti carbmylated proteins antibodies(Anti-CarP Abs).
The current study shows the following findings: Anti-Carp level is significantly higher in patients with RA in comparison to the control group (p<0.001). Both RA patients and control group had insignificant differences as regarding age, BMI and sex. Both sero positive ACPA and sero negative ACPA groups showed insignificant different regarding family history, duration of disease and extra articular menifestations. Both sero positive ACPA and sero negative ACPA groups showed significant different regarding disease activity(DAS 28 score), majority of sero negative ACPA had mild disease activity(53.3%) while majority of sero positive ACPA group had moderate (53.3%) and severe activity(26.7%).It was noticed that RA patients had significant lower HB level, protein and albumin level than control group, but they had significant higher random glucose level in comparison to control group. None of control had positive ESR, CRP, Anti-CCP or RF. There is no significant association found between Anti-CarP level with family history, morning stiffness, extra articular manifestations and RF level. Studying the relationship between Anti-CarP level and other disease markers, a significant association between only anti-ccp level and Anti-CarP level is found. According to disease activity, severity of disease had significant association with positivity of anti-CarP. DAS 28 score is moderately correlated with anti-CarP Ab titre. Anti-CarP had insignificant correlations with different parameters done with exception of significant positive correlation between anti-CarP and BMI. Anti-carp antibody is an useful biomarker in the diagnosis of RA even in ACPA sero negative patients. Anti-CarP Ab at cut off point 7 ng/ml had 47% sensitivity and 75% specificity that may have additive value besides other disease markers in early diagnosis of RA.