Thanks to ALLAH firstly and lastly. I would like to expres m■ profound and unlimited gratitude to PROF. DR. MOHAMMED Z•IKAREIA ERAQY, Professor and Head of Rheumatology and Rehabilitation Department, Benha Faculty of Medicine, Zagazig Universit■. his remarkable thoughts and kind generous supervision during the conduction of this work. It is my pleasure to express my deepest appreciation and gratitude to PROF. DR. MONIR SERAG ELDIN, Assistant Professor of Rheumatology and Rehabilitation. Benha Faculty of Medicine, Zagazig University, for his faithful ,urer% ision. guidance and help through the work. My cordial thanks arc !o DR. REFAATM. ELTANAWY, Lecturer of Rheumatology and Rehabilitation, Benha Faculty of Medicine, Zagazig University, for graciously supervising this thesis and for his unlimited effort, assistance and careful review. I would like to express my thanks to DR. Alf:-ID iVI, EL-ABD, Lecturer of Biochemistry, Benha Faculty of Medicine, Zagazig University, for his valuable efforts in achievement of this work. 1 would like to thank every went ber of my staff in Rheumatology and Rehabilitation department, for their support and advices . Thanks also to my colleagues and all members in Rheumatology and Rehabilitation department, Benha Faculty of Medicine for their cooperation and sympathy during accomplishment of my work. This work is dedicated to my family, whose constant encouragement means a great deal to me.