الفهرس 
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Abstract
The presence of autoantibodies against muscarinic acetylcholine receptor subtype 3(m3AChR) has been reported in primary Sjogren syndrome patients, and it is suggested that an immune reaction to (m3AChR) plays a crucial part in the pathogenesis of SS. Hence, the aim of this study was to assess the serum level of (m3AChR)- autoantibodies in RA patients, and to investigate whether its level in RA patients is correlated with the presence of 2ry Sjogren syndrome manifestations, and determine its relation to disease activity, severity & functional assessment. This study included ninety participants in total: 30 RA patients with manifestations of secondary Sjogren syndrome, 30 RA patients without manifestations of secondary Sjogren syndrome, and 30 apparently healthy volunteers matched in age and sex with the patients as controls. The patients were subjected to complete clinical assessment, assessment of disease activity using DAS28 score, functional assessment using modified health assessment questionnaire (MHAQ). Laboratory assessment including (CBC), (ESR), (CRP), Rheumatoid factor (RF), anti– cyclic citrullinated peptide (anti-CCP), and serum level of muscarinic acetylcholine receptor subtype 3 (m3AChR)- specific autoantibodies was done to all patients, while serum level of muscarinic acetylcholine receptor subtype 3 (m3AChR)- specific autoantibodies only was done to control group. The results of the study can be summarized as the following: • Regarding the demographic data of our participants, nearly most of RA patients with or without sSS, and the control group were females (83.3%, 86.7% and 76.7% respectively), with insignificant difference between the three groups (P>0.05). • The mean age of RA patients with sSS was (47.20 ± 9.91 years), while RA patients without sSS their mean age was (44.53 ± 9.05 years), with insignificant difference between the two studied groups (P>0.05). • Regarding the duration of the disease, the mean duration of the rheumatoid arthritis was insignificantly (P>0.05) longer in RA patients with sSS (12.73 ± 4.72years) than in RA patients without sSS (9.42 ± 4.69years), the mean duration of sicca symptoms was (8.73 ± 3.54 months) with range (1-36 months). • In the studied RA patients with sSS, the mean DAS28 was (4.19 ± 1.53), the number of tender joints was (mean 8.90 ± 4.12joints), the number of swollen joints was (mean 1.06 ± 0.28joints), VAS ranged from (1-100), the duration of morning stiffness was (mean 49.50 ± 24.15minutes), and the mean MHAQ score was (1.16 ± 0.54). • While the disease activity measures in RA patients without sSS, the mean DAS28 was (3.91 ± 1.53), the number of tender joints was (mean 7.47 ± 3.29joints), the number of swollen joints was (mean 1.03 ± 0.23joints), VAS ranged from (1-9), the duration of morning stiffness was (mean 48.83 ± 23.95minutes), and the mean MHAQ score was (1.14 ± 0.41). • There was no significant difference between RA patients with sSS and those without sSS as regard ESR (P>0.05) and CRP (P>0.05), mean ESR 1st hour was (31.77 ± 14. 27.63 ± 12.85mm/h respectively), and CRP was (41.34 ± 19.93, 34.06 ± 14.06 mg/l respectively). • While we found there was a significant difference between the levels of RF and anti-CCP in RA patients with sSS; (mean 110.23± 54.0 IU/ml, 297.3 ± 125.7 u/ml respectively), and RA patients without sSS; (mean. 77.25 ± 37.68 IU/ml, 171.3 ± 72.4 u/ml respectively). The level of m3AChR antibodies in our participants revealed significant increase of its level in RA patients with sSS; (mean 25.98 ± 4.81 ng/ml) in comparison to RA patients without sSS and healthy control (20.09 ± 4.24, 18.36 ± 3.59 ng/ml respectively). • Analysis of (ROC)-curve of m3AChR was performed and showed; AUC of 0.806, and there was highly significant difference between the studied groups, (P < 0.001), cutoff was (>22.63), sensitivity (73.33%) and specificity (86.67%). • Lastly, we found positive significant correlation between the level of m3AChR level and: DAS scores, MHAQ score, number of tender joints, swollen joints, VAS, ESR, and CRP (P<0.05).