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Abstract
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Rheumatoid Arthritis (RA) is a chronic systemic autoimmune disorder characterized by persistent synovial inflammation, joint destruction, and extra-articular manifestations. It affects approximately 0.5–1% of the global population, with a rising burden in Middle Eastern countries, including Iraq (Al-Rawi et al., 2022). Despite advances in RA management, early and accurate assessment of disease activity and prognosis remains challenging, particularly in resource-limited settings.
Current diagnostic markers such as rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies are insufficient in some patients, especially those with seronegative RA. Furthermore, the underlying immunological mechanisms driving disease activity and treatment resistance remain poorly understood in the Iraqi population. This limits the development of targeted and cost-effective immunological diagnostics and therapies adapted to the local context.
Understanding the balance between pro-inflammatory Th17 cells and regulatory T cells (Treg), along with innate immune mechanisms such as inflammasome activation (particularly IL-1β secretion via NLRP3 inflammasome), may offer new insights into RA pathogenesis and disease monitoring. Additionally, novel autoantibodies such as anti-Carbamylated protein (anti-CarP) antibodies may serve as alternative biomarkers, particularly in patients negative for RF and anti-CCP. There is an urgent need to identify immune-based biomarkers that are affordable, reliable, and specific to the immunogenetic and environmental background of Iraqi RA patients. Most immune profiling studies are based on Western populations, with limited regional data addressing the immune pathways in Middle Eastern patients.
The study could aid in identifying immune markers that predict disease severity or response to therapy, potentially guiding personalized treatment strategies in Iraq’s healthcare system, which often lacks access to expensive biologics
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