Purpose: To determine the value of Anti-CCP as predictor for disease activity in rheumatoid arthritis assessed by DAS-28, and to find the effect of smoking on disease activity in rheumatoid arthritis. Materials and Methods: One hundred patients with rheumatoid arthritis involved in this study, consisted of 88 female and 12 male who fulfilled the 2010 ACR-EULAR classification criteria for rheumatoid arthritis attending the rheumatology department in general hospital, or attended the center of rheumatology and rehabilitation in sulaimani city, for 6 months ( from October, 2012 to March, 2013). Thorough Demographic information of patients was recorded through history of age, sex, and history of smoking, disease duration, physical evaluation according to DAS-28. and serological test for RF and Anti-CCP. Results: There was highly significant association between DAS-28 and Anti-CCP value (p =0.0001). there was no significant correlation between DAS-28 and RF (p= 0.252),According to smoking there was highly significant association between smoking with Anti-CCP value and DAS-28 (p=0.003-0.0001) respectively while there was no significant association between smoking and RF(p=0.15). Conclusion: A highly significant correlation was found between Anti-CCP value and disease activity in rheumatoid arthritis, smoker patients had higher value of Anti-CCP compared to non-smoker patients. Smokers demonstrated a more active and severe disease activity compared to non-smokers.

Background: Ankylosing spondylitis (AS) is a chronic, progressive, and disabling disease among rheumatological diseases. Objectives: Current study aimed to investigate the Time lag between the onset of symptoms and final diagnosis of AS, and also identify the factors that contribute to that delay in Sulaymaniyah province. Methods: In this cross-sectional study, 104 (AS) patients who satisfied the modified New York 1984 criteria were enlisted. The time lag was defined as the diagnosis delay (DD) between the appearance of the first symptoms and the correct diagnosis of AS. Spearman correlation analysis was used to detect correlations between variables. Results: The higher percentage of variables with DD≥6 years were urban 32 (74.4%), housewife 15(34.9%), had no family history 42 (97.7%), with high diploma 33 (76.7%), and positive HLAB27 31 (72.1%), the first specialist consulted orthopedics 21(48.8%) then GP 6 (14.9). Moreover, the higher percentage of variables with DD<6 years were diagnosis years between 2000 to 2020, rural 55 (90.2), 39 (63.9%) respectively, higher education 47 (77%), employee and worker 22 (36.1%), positive family history 44 (72.1%), positive human leukocyte antigen (HLAB27-61) (100%), inflammatory back pain 47 (77%), rheumatologist 29 (47.5%). The average year’s DD is 6.48. A statistically significant positive correlation was detected between the DD and age, age at diagnosis but, a negative correlation was found between the DD time and, age at symptom onset. Conclusion: The Time lag between the onset of symptoms of AS and the final diagnosis in Sulaymaniyah was 6.48 years. (HLA-B27), age, age at diagnosis, education level, occupation, 1st specialist, 1st symptom at onset of disease and family history are the factors that affect delayed diagnosis in Sulaymaniyah patients with AS.

Background: The risk of fractured vertebral increases in patients with rheumatoid arthritis as they are more likely to suffer from osteopenia, and osteoporosis. Objectives: This study aimed to investigating the rate and risk factors of vertebral fractures in patients with rheumatoid arthritis. Methods: We recruited 201 patients aged between 30 and 70 who attended the rheumatology department at Shahid Hemn Teaching Hospital in Sulaymaniyah, between January and September 2022. Medical records were reviewed for disease and treatment characteristics while also clinically evaluated by a rheumatologist. Spinal radiographs were assessed by two experienced radiologists blinded to patients’ clinical diagnosis and status. Compression fractures were classified by using the Genant semiquantitative method, and the type of fracture was classified as wedged fracture, biconcave fracture, or crushed fracture. Results: Of the 201 included participants, 151 were female, and 50 were male. The BMI of women was higher than men by nearly four points (P<0.001). Most women were also illiterate (68/151, 45.0%) and unemployed (139/151, 92.1%). Hypertension (28.4%) and diabetes mellitus (14.4%) were the most reported comorbidities. Women were more likely to have higher DAS28 scores while men had more vertebral fractures (P=0.003). The probability of fractures increased with age, male sex, and illiteracy compared to primary school, osteopenia, and osteoporosis through simple and multiple logistic regression models. Conclusion: With at least one fracture affects females and males at a rate of 27.8% and 52.0%, respectively. Also reported that age, male sex, illiteracy, osteopenia, and osteoporosis significantly increase the risk of fractures.

Lupus nephritis is one of the most serious manifestations of Systemic lupus erythematosis and it is a major cause of morbidity and mortality. The aim of this study is to compare males and females in lupus nephritis presentations. Material and Methods: A cross-sectional study performed on forty five patients with biopsy proven Lupus Nephritis including 32 females and 13 males. All patients assessed by questionnaire form and investigated for hematological, biochemical, immunological, serological, urinalysis, and 24hrs urinary protein excretion. Results: The current study shows female predominance 32(71.1%) compared with 13(28.9%) male. Class IV 15(33.3%) nephritis was the most common type followed by class III 9(20.9%).The male patients develop nephritis early in the course of Systemic lupus erythematosis than females, and they were more commonly had hypertension and edema, and the hematological, cardiovascular, pulmonary, and central nervous system were the most common extra renal manifestation in males while mucocutaneous manifestations were the commonest in females, and further more males had more proliferative type of Lupus nephritis than females. Conclusion:Males had more severe type of lupus nephritis than females. AnahtarKelimeler: Systemic lupus erythematosis, Lupus nephritis, sex. ÖZET Amaç:Lupus nefriti sistemik lupuseritematozusun en ciddi belirtilerinden biridir ve morbidite ve mortalitenin esas sebebidir. Bu çalışmanın amacı lupus nefriti olgularında erkek ve kadınlar arasında karşılaştırma yapmaktır. Materyal ve Metod:Biyopsi ile Lupus nefriti olduğu kanıtlanmış 45 hasta (32 kadın, 13 erkek) üzerinde kesitsel çalışma uygulandı. Tüm hastalara anket yapıldı. Hastalara biyokimyasal, immünolojik, serolojik, hematolojik tetkikler ve idrar tahlili yapıldı. 24 saatlik idrarda protein atılımına bakıldı. Bulgular:Yapılan çalışmaya göre kadınların (32, %71.1) erkeklere (13, %28.9) nazaran daha baskın olduğu görülmüştür. En yaygın tip olarak 4. sınıf nefriti (15, %33.3) sonrasında ise 3. sınıf nefriti (9, %20.9) görülmüştür.Sistemik lupuseritematozuslu erkek hastalar, kadınlardan daha erken bir dönemde nefriti geliştirmişlerdir.Erkeklerde daha yaygın hipertansiyon ve ödem vardı.Kadınlarda böbrek dışında en yaygın belirti mukokutanöziken erkeklerdehematolojik, kardiyovasküler, solunum ve merkezi sinir sistemi manifestasyonu görülür.Kadınlara nazaran erkeklerde daha fazla proliferatif tipte lupus nefriti gözlenmiştir. Sonuç:Erkeklerde kadınlara nazaran daha ciddi tipte lupus nefriti görülmüştür.

Find out the relationship between body mass index (BMI) and W.C with disease activity scorein AS patients and its association with clinical characteristics of AS. One hundred and five patients (75 male and 30 female) who visited rheumatology and medical rehabilitation centerin Sulaimani city were recorded in this cross-sectional study. Disease activity was measured by ASDAS-ESR in the hand-held calculator.BMI was calculated and waist circumference(W.C.) was measured and both were evaluated with disease activity score and disease characteristics in those with normal BMI and W.C and those with abnormal BMI and W.C.Data of one hundred and five patients were involved in this study with a mean age of 37±9.5 years with the predominance of male gender (71.4%). The mean BMI of the patients was27.2±4.6 kg/m², 28.6% of them were obese and 35.2% of them were overweight. Patients who were overweight, obese and increased W.C had significantly higher disease activity scoresand older compared to those who had normal BMI and W.C(p value<0.05).There was no statistically significant difference between the two groups in terms of peripheral arthritis,disease duration, clinical characteristics of AS, and gender (P value>0.05). Overweight, obesity and increased W.C are common among AS patients and significantly related to disease activity score and age, but not with disease characteristics and gender