المستخلص: التهاب المفاصل الرثوي هو احد امراض المناعة الذاتية الاكثر شيوعا والذي يتميز بالتهاب المفاصل المزمن والذي يؤدي فيما بعد الى تدمير المفاصل.لا يزال مرض التهاب المفاصل الرثوي يعرف على انه سمة من التوسع في الغشاء الزليلي وارتشاح الخلايا الالتهابية اضافة الى | Rheumatoid arthritis (RA) is one of the most common systemic autoimmune diseases characterized by chronic joint inflammation and subsequent joint destruction. It is well known that RA is characterized by the expansion of the synovium and infiltration of the inflammatory cells coupled with destruction of adjacent articular cartilage and bone. This is strongly dependent on CD4 T cell. CD4 Cells stimulate monocytes, macrophages, synovial fibroblasts, and other cells to produce cytokines such as tumor necrosis factor - ? (TNF - ?), interleukin - 1 (IL - 1), IL - 6, IL - 15, IL - 17 and metalloproteinases that produce tissue damage. TNF is a major inflammatory cytokine contributing to the pathogenesis of RA, which provides rational for development of anti - TNF biological agents in the treatment of RA.Wnt pathway (a complex protein network) important in control of the bone formation through the regulation of osteoblast activity, and sclerostin is an important in the regulator of the Wnt pathway by blocking Wnt binding to its receptor and thereby inhibiting bone formation. Blockage of Wnt antagonists such as sclerostin will trigger repair or even healing of bone erosion.Recently have shown that IL - 1Ra has been given therapeutically in several experimental models of arthritis with weak effect in RA. This study planned to evaluate the frequencies of CD4+CD25+ Treg cells in Iraqi patients treated with RA under treatment with biological therapy (Etanercept). The level of serum sclerostin, serum level of IL - 1RA, and investigate the correlation between serum sclerostin and Treg expression. Correlate the level of serum sclerostin and Treg expression with disease activity by (CDAI or DAS28).This study was performed during the period from January 2016 to May 2016.The patients were attending the out patients' Clinic in Medical City/Baghdad Teaching hospital/Rheumatology Unit and the laboratory Enzyme Linked Immunosorbent Assay tests were done in Bio - technology center at the University of Al Nahrain, flow cytometery analysis was performed in the private laboratory (Al Rawabi Laboratory) at Yarmouk/Baghdad. Thirty patients and 30 apparently healthy control individuals were included in this study, Patients under treatment of etanercept.The diagnosis of RA patients has performed under the rheumatologist consultant at the consultation clinic of Baghdad Teaching Hospital of the medical city. Blood samples had taken from RA patients to measure Erythrocyte Sedimentation Rate, Complete Blood Picture, Rheumatoid Factor and High - Density Lipoprotein. Also, analyze the serum levels of Anti - Citrullinated Protein Antibodies and estimate the levels of sclerostin and IL - 1RAin patients and healthy individuals using Enzyme Linked Immunosorbent Assay test kits. CD4+CD25+ Treg cells had achieved by flow cytometery analysis.The results showed the reduction in Treg cells in patients (0.00264 ± 0.002) % under biological therapy than control group (0.026 ± 0.012) % with significant difference (p< 0.05). Also body mass index showed significant difference between patients (32.10 ± 5.81) kg/m2 and control group (28.84 ± 4.67) kg/m2 (p< 0.05). The results showed that sclerostin level higher in healthy (1.072 ± 0.59) ng/ml than patients (0.801 ± 0.28) ng/ml which showed significant difference (p<0.05). Furthermore IL - 1RA serum level was higher in healthy (0.979 ± 0.34) ng/L than patients (0.633 ± 0.35) ng/L with significant difference (p<0.05). Anti - Cyclic Citrullinated Peptide results showed non - significant difference between patients and healthy control. Treg cells is reduction in the patients with RA. Sclerostin and IL - 1RA levels are low in patients treated with etanercept.

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