This study aimed to measure serum and synovial fluid (SF) levels of GITR in patients with recent onset RA before and after initiation of therapy

1. Technical design:

   Study design: a longitudinal observational cohort study.

   This study will be carried out on two groups:

   • Group (I): fifty early onset rheumatoid arthritis (RA) patients fulfilled the 2010 American college of rheumatology (ACR) - European league against rheumatism (EULAR) classification criteria for RA [11].
   • Group (II): Twenty healthy individuals of matching age and sex as control group.

   Both groups will be recruited from the in-patients and out-patients' clinic of the Rheumatology, Rehabilitation& Physical Medicine Department, Benha University Hospital.

   All patients will be evaluated at baseline at 6 months follow up using:

   (A) Clinical evaluation 1. Complete history taking. 2. Thorough clinical examination. 3. Disease activity using DAS28 [12]

   (B) Laboratory assessment:

   All patients will be subjected to the following measurements:

   1. Erythrocyte sedimentation rate (ESR).
   2. C reactive protein (CRP).
   3. Rheumatoid factor (RF)
   4. Anti-cyclic citrullinated peptide (Anti- CCP).
   5. glucocorticoid-induced tumour necrosis factor receptor related protein (GITR)

   (D) Musculoskeletal ultrasound assessment: Ultrasound examinations will be performed for patients and control groups using a Logiq e equipped with a broadband 8- to 13-MHz linear transducer

2. Statistical analysis The collected data will be tabulated and analyzed using suitable statistical computer version.

Inclusion Criteria:

• fulfill 2010 criteria for classification of rheumatoid arthritis recentely diagnosed

Exclusion Criteria:

• infection malignancy receiving treatment

2 groups: first: recently diagnosed RA patients 2nd : healthy control ( age and sex matched)