الفهرس 
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Abstract
Ankylosing spondylitis (AS) is a systemic chronic inflammatory
autoimmune rheumatic disease characterized mainly by involvement of
sacroiliac joints and axial skeleton, showing a strong genetic predisposition
with an unknown etiology. In addition to inflammatory low back pain with
or without peripheral arthritis, extra-articular manifestations including
anterior uveitis, aortic valve insufficiency, cardiac conduction disorders,
apical lung fibrosis, or secondary amyloidosis may also be seen.
Aim Of The Work
The aim of this work was to evaluate thyroid functions and thyroid
autoantibodies in ankylosing spondylitis patients on anti-TNF-alpha and its
relation to disease activity.
Patients and Methods
All patients diagnosed as ankylosing spondylitis (AS) according to
ASAS classification criteria. Patients were recruited from Physical
Medicine, Rheumatology and Rehabilitation Outpatient Clinic in Al-
Menoufia University Hospitals and collected over a period of 6 months.
Patients were classified into two groups all diagnosed as of ankylosing
spondylitis:
group I: Patients treated with non-steroidal anti-inflammatory drugs
(NSAIDs).
group II: Patients treated with anti-TNF-.
All patients were subjected to history taking, complete clinical
examination to assess the lumbosacral, sacroilial and peripheral joints; as
well as assissing the disease activity, functional disease activity and spinal
mobility.
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Summary
Investigations used to help in diagnosis were complete blood picture;
erythrocyte sedimentation rate; c-reactive protein titer; thyroid functions
tests; anti-thyroid peroxidase antibody titers; HLA-B27 as well as neck
ulsonography to assess the thyroid gland.
Results
The results of our study revealed that there was a significant
difference between both groups regarding disease duration (P = 0.01). In
NSAIDs group, all patients (76.7%) were male smokers while (23.3%)
were non-smokers. In anti-TNF- group, (53.3%) were smokers while
(46.7%) were non-smokers {P = 0.007, (Table 4, Fig. 9)}.
Also, There was a significant difference between both groups
regarding disease duration (P = 0.01). Also, there was significant difference
regarding BASDI (P = 0.005), BASMI (P = 0.000) and BASFI (P = 0.013).
Our results revealed that laboratory investigation revealed a
significant reduction in the mean value of CRP, TSH, Anti-TPO, HLA-B27
and significant reduction in the percentage of positivity of HLA-B27 in
anti-TNF- group than in NSAIDs group {P = 0.005, 0.001, 0.00, 0.002
and 0.007 respectively, (Table 8, Fig. 11)}. While there was no significant
difference between both groups regarding ESR, FT3 and FT4 (P = 0.223,
0.257, 0.531) respectively.
from this study we can conclude that thyroid autoimmune disease
presented in a good proportion with ankylosing spondylitis and treatment
with anti-TNF- helps to control the immunogenecity of ankylosing
spondylitis and lower the incidence of occurrence of thyroid disorders with
that disease. So, we recommend the use of anti-TNF- agents in
management of ankylosing spondylitis for its beneficial effect in
controlling immunogenecity of this disease and to help in lowering the
incidence of occurrence of thyroid disorders with that disease.