الفهرس 
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Abstract
Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory, and autoimmune disease that affects approximately one percent of adults worldwide., positive family history of RA increases the risk of RA with higher levels of multiple cytokines found to be associated with RA-related autoantibody positivity in FDRs without clinically apparent RA.
This is a cross sectional observational study aiming to detect early synovitis (preclinical stage of RA) among healthy FDRs of RA patients by MSUS and its correlation with serological markers. Sixty healthy FDRs of RA patients were enrolled.
Laboratory investigations included: ESR, CRP, RF, anti-ccp, HBsAg, HCV-Ab, radiological investigations: Seven joints of the clinically dominant hand and foot were sonographically evaluated in grayscale and Doppler flow using US7 score. US7 score was conducted on the following joints: wrist, MCP II, III, PIP II, III, MTP II, and V which were assessed for synovitis, tenosynovitis/paratenonitis, and erosions.
Among the studied FDRs, 4 FDRs (6.7%) had positive RF, 2 (3.3%) had positive anti-ccp, positive MSUS findings were detected in 31 FDRs (51.6%); of whom 18 (58%) had arthralgia and 13 (42%) had no arthralgia, and 29 (48.3%) of FDRs had no MSUS finding. Synovitis by Gray Scale was the commonest finding, as it was recorded in 31 FDRs (51.6%), tenosynovitis/paratenonitis was present in 2(3.3%) FDR. No erosions were detected in all subjects (0.0%). The wrist was the most commonly involved joint followed by MTP-II joint.
The recruited subjects into two groups according to the cumulative positivity of the ultrasound results: group 1; with positive MSUS findings and group2; with negative findings, there was no significant difference between the two groups as regards demographic, clinical and laboratory parameters except for ESR which was significantly higher in FDRs with positive MSUS.
The recruited subjects were further subdivided into two groups according to the cumulative results of the presence of clinical arthralgia and US findings: group A; 16 subjects (26.6%) with positive both arthralgia and MSUS findings, and group B: 44 (73.4%) FDRs with no arthralgia or negative US findings, or negative both. Comparison of both groups revealed that group A subjects had longer duration of arthralgia and significantly higher CRP than group B subjects. This finding suggests that as the duration of arthralgia increases in FDRs, MSUS abnormalities are more likely to be found.
The relation between GSUS score and ESR in the recruited subjects was stastically significant.
Regarding evaluation of diagnostic methods, clinical arthralgia had the best sensitivity (58%), followed by RF (9.6%) and the lowest was anti-ccp (3.3%). Regarding specificity, RF had equal specificity as anti-ccp while clinical arthralgia had the lowest specificity. RF gave the best PV +ve (75%), followed by approximate values for both anti-ccp and clinical arthralgia.
We found that positive RF gives three times relative risk of abnormal US findings. RF gives the best AUC being (67.0%), followed by anti-ccp (52%), then the arthralgia (44%).
We considered the ultrasound results as dependent variable that we predicted to be influenced by different independent variables as age, smoking, BMI, arthralgia, ESR, CRP, RF and anti-ccp. Both arthralgia and ESR showed significant relation with ultrasound results under the influence of the other included variables.