الفهرس 
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Abstract
Rheumatoid arthritis (RA) is a chronic, systemic, progressive autoimmune disease, that principally attacks the joints in a systemic pattern producing an inflammatory synovitis that often progresses to destruction of the articular cartilage and ankylosis of the joints (Hekmat et al., 2011).
In this study, we assessed the role of serum PAD4 in RA through its relation with clinical parameters and disease activity and comparing it with the Anti CCP level in RA patients.
This study was carried out at Ain shams Rheumatology and Rehabilitation Outpatient Clinic. The study included 42 subjects, 31 patients with Rheumatoid arthritis and 10 healthy individuals as a control group. RA patients were 26 females and 5 males whose ages ranged from 29-60 years with a mean age of 42.0±39.6 years.
All RA patients were subjected to detailed history taking, clinical examination, calculation of DAS28, PGA and MHAQ and ESR. Serum PAD4 and Anti-CCP were measured in RA patients and healthy controls using quantitative ELISA technique and compared to results of the RA patients.
Statistical analysis of the obtained clinical and laboratory data showed a significant elevation of serum PAD4 in RA patients 532.9±240.9 pg/ml when compared to controls 156.0±31.0 pg/ml, as well an elevation of serum Anti CCP level in RA patients 129.284 ±74.85 ng/ml more than controls 8.4 ± 4.4ng/ml. PAD4 sensitivity was 90.3% and specificity was 100% while anti-CCP sensitivity was 93% and specificity was 100 %.
Follow up of patients after 3 months showed no statistically significant decrease in the serum level of PAD4 and AntiCCP also the disease activity grades of patients showed no significant changes, however, we had 8 improved patients who had significant lower serum PAD4 in comparison to not improved patients. While, there was no significant difference in serum Anti CCP between the improved and the not improved cases.
In this study we found positive correlations between changes in serum PAD4 and change in DAS28, MHAQ score, number of tender and swollen joints and ESR while no correlations were found between the serum AntiCCP and the above mentioned data.
In conclusion, our study highlighted that PAD4 sensitivity was 90.3% and specificity was 100% while anti-CCP sensitivity was 93% and its specificity was 100%. According to these findings serum PAD4 provide additional diagnostic value not over the already established anti-CCP, but it is correlated with disease activity and can be used in follow up remission in RA patients.