Assessment Of Rheumatoid Activity Based On Clinical Features Blood And Synovial Fluid Analysis:

Monir Serag El-din El-hanafi

- 126 -SUMMARY & CONCLUSIONThe aim of this work is to assess clinically the Jointdisbility and to measure blood and synovial fluidparameters from patients with ~heumatojd disease and todetermine which are related to clinical activity and whichare most useful.40 patien~having rheumatoid arthritis were selectedfrom the out-ptient clinic at Benha unlvers•y hospital.Theyincluded 6 males and 34 females with age ranging from 35 to60 years with a mean age of 45.63=7.57 the selected casesfulfilled the criteria necessary for diagnosis ofrheumatoid arthr~~.is according to the Revised AmericanRheumatism Association criteria (Arnett et al .. 1988). Eachp~tient was investigated to show evidence of diseaseactivity as defined by the presence of at least three ofthe following; Eryth rocyte sedimentation rate of 30 mm. orhigher. 45 minutes or more of morning stiffness. Ritchiearticular index of 10 or more. the presence of 6 or morepaniful Joints and 3 or more swollen joints. All patients- 127 -had persistant synovitis of ’the knee.All patients were subjected to the tbllowing:-Full history taking with stress on duration ofmorning stiffness in minutes._ Clinical examination with stress on the locomotorsystem, including the following :-Joint tenderness according to the method of Rithieet al., (1968), counting the number of panifuljoints, and the number of swollen joints andmeasurement of grip strength of both hands.Blood analysis including the followingErythrocyte sedimentation rate, Haemoglobinconcentration, C-reactive protein total leucocyticcount and latex fixation titre rheumatoid factor.Synovial fluid analysis including the folpwing :-Glucose level, latex fixation titre rheumatoidfactor,count.Correlation coefficients was made for each item ofthe clincal , blood and synovial fluid.tota I Ieucocyti c count and ’poIYlllO..!JlhsOur findings in this work can be summarized in the- 128 -following :-Significant correlationsedimentation rate and thedisease activity.- Significant correlation between C-reactive proteinand the clinical parameters of disease activity.Insignificant correlation between haemoglobinconcentration and the clinical parameters of diseaseactivity.Insignificant correlation between total leucocyticcount and the clinical parameters of disease activity.-Insignificant correlation between rheumatoid factortitre and the clinical parameters of disease activity.Insignificant correlation between glucose level inthe synovial fluid and the clinical parameters ofdisease activity.- Insignificant correlation between rheumatoid factortitre in the synovial fluid and the clinicalparameters of disease activity.- Significant correlation betweencount in the synovial fluidparameters of disease activity.- Significant correlation between polymorphs count inbetweenclinicalerythrocyteparameters oftotal leucocyticand the clinical- l~~ -the synovial fluid and the clinical parameters ofdisease activity.Lastelly. it can be concluded that, four parametersare most accurately reflect disease activity and correlatedsignificantly with all parameters of disease activity inrheumatoid arthritis patients:-1- Erythrocyte sedimentation rate2- C-reactive protein3- Total leucocytic count in the synovial fluid4- Polymorphs count in the synovial fluidOur four indices are simple and should assisst thosewho wish to assess progress of disease.