COMPARATIVE STUDY OF THE EFFICACY OF GOLD,METHOTREXATE AND THE COMBINATION OF METHOTREXATE AND AZATHIOPRINE IN THE TREATMENT OF RHEUMATOID ARTHRITIS

Abstract

Rhe.umatoid arthritis (RA) is an autoimmune disorder of unknown etiology characterized by symmetric erosive synovitis and sometimes multisystem involvement therefor it is better named rheumatoid disease.<l) Most patients exhibit a chronic fluctu'ating course of disease that, if left untreated, results in progressive joint destruction, deformity, disability, and premature death < 2 .

It is proposed that the pathogenesis of (RA) is (a T cell) mediated disease, following which a largnumber of subsequent inflammatory events are released <3>.

Several cell adhesion molecules (CAMs) families play an important

role in the extravasations of circulating leukocytes into tissues. A process I that is essential for many inflamma;ory and autoimmune disease (4).

Intercellular adhesion molecule-1 (ICAM-1): plays a vital role in the migration of lymphocyte into and' out of the tissue, excessive induction of cell adhesion molecules on the vascular endothelium might result in the accumulation of lymphocytes in the rheumatoid synovium. Interaction of immunocomptent cells with endothelium as will as extravascular matrix through adhesion molecules is a critical for the pathogenesis of RA (s). Serum levels of the soluble from of the intercellular adhesion molecule-1 (ICAM-1) have been advocated as a parameter of clinical relevance in determining the activation of the immune inflammatocy·disease<6 . ICAM-1 is more broadly distributed than the other adhesion molecules, being found on endothelium, macrophages, some lymphocytes in RA (7). There is no