الفهرس 
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Abstract
Rheumatoid arthritis is a chronic inflammatory autoimmune disease characterized by articular damage and extra-articular manifestations. The exact etiology that elicits RA disease is still unknown, but recently, it is believed to be elicited by genetic and environmental risk factors that stimulate various cytokines to participate in RA pathogenesis. One of these cytokines is Macrophage migration inhibitory factor (MIF).
MIF is a pleotropic inflammatory cytokine which was reported to increase in synovial fluid, and cultured synovial fibroblasts of RA patients due to its inflammatory role at these sites in RA disease.
Vitamin D is a fat-soluble pro-hormone, that is obtained from dietary intake or produced in the skin by ultraviolet B from sunlight. It is well known for its important function in calcium homeostasis and bone health. But in the late decades, the discovery of vitamin D receptors (VDR) expression on many immune cells (eg. Macrophages, Dendirtic cells, T- & B- lymphocytes) suggested an immune modulatory function of vitamin D.
Thus, we decided to determine the connection between RA in one hand and both of MIF & Vitamin D on the other hand. So, we aimed to detect the serum levels of MIF and 25 (OH) vitamin D levels in RA patients and to evaluate their relation with the disease activity and then find the relation between both MIF and vitamin D.
Eighty-seven Samples were obtained (52 RA patients and 35 apparently healthy controls), and vitamin D and MIF serum levels were analyzed. Disease activity score (DAS) 28 and clinical disease activity index (CDAI) were assessed. Statistical correlations between RA disease activity and both MIF and vitamin D serum levels were performed, as well as between MIF and vitamin D serum levels.
In this study, we found that, almost all the RA patients were females (96.2%) and only (3.8%) were males. The average age of the cases was (46.06 ± 8.13), while that of the control was (43.74 ± 5.43). The studied RA cases had significantly higher Vitamin D levels as compared to studied controls (18.46 ± 9.17 vs. 10.42 ± 5.35, P<0.001), and significantly lower MIF (10.94 ± 5.48 vs. 21.52 ± 16.49, P<0.001). No significant correlation was observed between serum Vitamin D and MIF among the studied RA cases (r= - 0.293, p=0.103). The serum MIF level showed no significant difference among the different disease activity categories (DAS28 & CDAI) (P=0.457, P=0.523 respectively). The same case was observed concerning the serum vitamin D level and the different DAS28 categories (P=0.854), and the CDAI categories (P=0.115).