αβ DNT cells percentages are elevated in patients with JSLE and their percentages correlate with disease activity. Further studies are needed in conjunction with the proinflammatory cytokine profile, apoptotic assays and histological findings.

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Background: rheumatoid arthritis (RA) is a chronic inflammatory arthropathic with multiorgan involvement. Increased prevalence of insulin resistance (IR) has been observed in patients with RA. Highgrade systemic inflammation is implicated in the development of IR in these patients. Tumor necrosis factoralpha (TNF-α) is a potent proinflammatory cytokine that plays a role in initiation and progression of inflammation and the mechanisms associated with accelerated atherosclerosis in RA. Aim of the work: this study aimed to investigate the relation between TNF-α and IR in RA patients and its relation to disease activity. Patients and methods: 40 RA patients were included as the patient group and 40 healthy subjects as the control group. Both groups were subjected to full history, clinical examination including body mass index (BMI) and lab investigation, fasting blood glucose, fasting insulin and TNF-α. Results: the sex distribution was the same in patients and the control groups, 82.5% females and 17.5% males. The disease activity (DAS score) was 4.57 ± 1.35. TNF-α median was 240 with IQR 190-510. RA patients had significantly higher serum TNF-α than controls (p value = 0.001). BMI and Waist Circumference among RA patients and controls showed no significant difference. TNF-α has significantly positive correlations with fasting serum insulin, HOMA-IR and disease activity in RA patient group (p value < 0.001). Conclusion: serum TNF-α level was significantly higher in RA patients than the control groups with positive correlation in fasting serum insulin, HOMA score and disease activity.

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Background Rheumatoid Arthritis (RA) is a common autoimmune disease with a complex pathogenesis involving multiple genetic and environmental factors. The management of RA rests on several principles. Drug treatment, which comprises disease-modifying antirheumatic drugs (DMARDs), non-steroidal anti-inflammatory drugs and glucocorticoids (GCs), as well as non-pharmacological measures, such as physical, occupational and psychological therapeutic approaches, together may lead to therapeutic success. However, the mainstay of RA treatment is the application of DMARDs. Methotrexate is an antifolate and antimetabolite; it’s one of the DMARDs. Long term therapy with methotrexate has been associated with development of fatty liver and hepatic fibrosis. Liver biopsy is the standard method for diagnosing liver fibrosis, but it may be associated with significant morbidity and mortality of up to 0.33% thereby limiting its use. So the use of noninvasive markers of hepatic fibrosis such as serial platelet counts, FIB 4 score, ALT/AST ratio and recently serum PIIINP become mandatory. Objectives to evaluate the reliability of PIIINP in the screening for hepatic fibrosis induced by long term methotrexate therapy in rheumatoid arthritis patients compared with FIB 4 score and ALT/AST ratio. Patients and Methods This case study included 90 RA patients categorized into 60 RA patients on MTX therapy (group I), 30 RA patients on other medications (group II). All participants were subjected to full history taking, thorough rheumatological examination and lab investigations including complete blood count (CBC), ESR, CRP, AST, ALT, RF and measurement of serum PIINP levels, DAS and FIB-4 score were calculated. Results Patients in group I showed significant increase in serum PIIINP compared to patients in group II. There was significant negative correlation between disease duration, Platelets count and serum PIIINP levels in patients of both groups. There was significant negative correlation between folic acid intake and serum PIIINP levels of group I. There was significant positive correlation between Mean Corpuscular Volume, AST, ALT, AST/ALT ratio, FIB-4 score and serum PIIINP levels in patients of both groups. There was significant positive correlation between MTX dose and duration and levels of serum PIIINP in patients of group I. Conclusion Serum PIIINP levels could be used as non invasive marker for screening for hepatic fibrosis induced by long term MTX therapy in RA patients.