Background: Rheumatoid arthritis is a chronic inflammatory autoimmune disease characterized by joint inflammation, involvement of exocrine salivary and lacrimal glands may occur as extra-articular mani¬festations in this disease. This study aimed to provide evidence of altered in function and composition of salivary gland in patients with rheumatoid arthritis by determine salivary flow rate and some biochemical parameters(total protein, amylase, peroxidase) and to investigate the relationship between disease activity and changes in function and composition of salivary gland.
Materials and Methods: Fifty five patients with RA (7 males and 48 females) were enrolled in this study with age range (20-69) years. The patients were separated into two groups in proportion to their salivation: normal salivation group (37) and hypo salivation group (18). Thirty five (9 male and 26 female) apparently healthy volunteers were also participated in the study. Three ml of unstimulated saliva was collected from all patients and control to determine salivary flow rate on one hand and salivary total protein, α-amylase and peroxidase by colorimetric method on other hand.
Results:Resultsshowed that there is highly significant decrease (P< 0.01; p< 0.001) in the median salivary levels of (flow rate, total protein, α-amylase and peroxidase) among RA patients when compared to control. There was highly significant reduction (P< 0.01) in median salivary levels of flow rate, total protein, α-amylase and peroxidase in two study groups (normal salivation and hypo salivation) as compared to that in control group. Also the levels of all these parameters (sialometry and sialochemistry) were significantly decrease (P =0.00) in RA patients with hypo salivation as compared to that in patients with normal salivation. There was strong positive correlation between total protein and salivary flow rate (r= 0.651, P=0.000), in one hand, and on the other hand, there was strong positive correlation between α-amylase and both salivary flow rate (r=623, P= 0.000) and total protein r=658, P=0.000). 
Conclusion: These findings indicate that the changes in salivary composition may represent involvement of salivary glands in patients with rheumatoid arthritis.

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An Impairment of Salivary Gland Function in Rheumatoid Arthritis: Association with Change in Salivary Biomarkers and Disease Activity

Background: Rheumatoid arthritis (RA) is a chronic multisystemic disease which can lead to significant deformities and functional disability. Objectives: is to estimate level of salivary Leptin, flow rate and pH of saliva among group of patients with rheumatoid arthritis according to treatment. Patients and methods: Study design ;a case control study included Fifty women patients with rheumatoid arthritis; twenty-five on Methotrexate treatment and twenty-five on combination treatment of Methotrexate and Etanercept selected as study groups with an age range (30-40) years old and twenty-five gender, age and Body Mass Index matched healthy looking persons were selected as control. Collection of unstimulated salivary samples was carried out under standard conditions then salivary flow rate, pH in addition salivary Leptin was estimated Results after adjustment for age, gender and body mass index; mean salivary flow rate was highest among rheumatoid arthritis cases on combination treatment (Etanercept and Methotrexate) =0.4±0.202 ml/min and least significant difference test between groups was statistically significant (p< 0.05). The mean salivary pH was highest among rheumatoid arthritis cases on combination treatment (Etanercept and Methotrexate) =7.1±0.29; however the differences between groups failed to reach the level of statistical significance. The median of salivary Leptin was highest among rheumatoid arthritis cases on Methotrexate =0.65ng/ml without statistically significant difference between groups, furthermore the salivary levels of Leptin in this study reveals weak correlation with disease activity score 28 r=0.127/p=0.42 among rheumatoid arthritis patients.  Conclusions: the whole unstimulated salivary flow rate was higher among rheumatoid arthritis cases on combination treatment (Etanercept and Methotrexate) revealing improvements in salivary gland functions, the study also concluded that salivary Leptin level is of low importance to assess disease activity to rheumatoid arthritis patients . Keywords: rheumatoid arthritis, salivary flow rate, salivary Leptin

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Ali Y. Majid

Papers

Salivary Leptin, pH and Flow Rate Among a Group of Patients with Rheumatoid Arthritis In Iraq