Background: Rheumatoid arthritis (RA) is a systemic autoimmune disease causing symmetrical articular destruction with extraarticular manifestations that include pulmonary manifestations, which are major contributors to morbidity and mortality. Aim of The Work:To detect the prevalence of vitamin D deficiency and its relationship to pulmonary affection in RA patients and correlate it with disease Activity . Patients and Methods:The study is a cross sectional one, carried out on fifty patients with RA recruited from the Chest and Rheumatology Outpatient Clinics of Al Hussein University Hospital. All patients diagnosed with RA who fulfilled the American Colleague of Rheumatology/European League against Rheumatism 2010 classification criteria. Results: In our study there was statistically significant (p-value = 0.002) increased DAS score in deficient patients (5.4 ± 0.8) when compared with insufficient patients (4.9 ± 0.4) and sufficient patients (4.1 ± 0.8). In our study there was statistically significant relation (p-value < 0.05) between vitamin D status and pulmonary manifestations (Exertional Dyspnea, Dry Cough, Chest Pain, Wheezing and Leathery Crepitation) which more frequent in deficient than insufficient and sufficient patients. In our study there was highly statistically significant (p-value < 0.001) decreased FVC in deficient patients (89.3 ± 20.1) when compared with insufficient patients (113.4 ± 7.1) and sufficient patients (114.8 ± 3.4). No statistically significant relation (p-value > 0.05) between vitamin D status and FEV1 & FEV1/FVC. Conclusion: RA disease activity score (DAS-28 score) and pulmonary manifestations in RA patients were more prevalent in Vitamin D deficient than insufficient and sufficient patients.

Background: Osteoarthritis (OA) knee pain is a global source of impairment. Additionally, it has a detrimental effect on socioeconomic status. Detecting the site of pain represents an essential technique for diagnosing clinical issues and determining suitable treatments. Aim of The Work:To detect the pattern and site of knee pain in patients with knee OA confirmed by X-ray and their effect on the functional status.Patients and Methods: a cross-sectional study included 100 patients with primary knee OA. Diagnosis was according to American College of Rheumatology (ACR) criteria. The Photographic Knee Pain Map (PKPM) has been used to detect pain sites. Participants have undergone Plain X-rays and graded according to Kallgren-Lawrence (K-L) radiograph. The physical status has been defined by The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results: Participants' ages have ranged from 35 to 62 years, with an average of 47.6 ± 6.3 years. Most patients are females (88%). Most patients have experienced morning stiffness (79%) with a duration ranging from 5 to 20 minutes (mean 11.2± 5.7 minutes). The mean VAS for pain has been 6.95± 0.97. The pain has ranged from moderate (29%) to severe (71%), with no patients experiencing mild pain. The mean WOMAC score has been 46.29±13.03. The prominent locations of pain in the left knee have been the medial region (6%), local inferior medial (6%), diffuse knee pain (20%), and patella (25%). In comparison, the main sites at the right knee have been diffuse knee pain (14%), medial joint (16%), and patella (41%). Intense regular duties have been the most challenging task, with an average of 3.26±0.85 (severe to extreme 3-4), then going upstairs (3.03±0.70) (severe to extreme 3-4), followed by going downstairs (2.6±0.92), then getting in and out of a car (2.54±0.83), and shopping (2.43±1.01) (moderate to severe 2-3). Conclusion: Majority of patients with knee OA had moderate level of knee pain and functional disability in daily living and they had the ability to localize site of pain. Also, the severity of knee pain and stiffness may influence the degree of disability in OA patients. As a result, OA treatments can be based on clinical aspects and functional status rather than relying on radiological findings.