**5. The stress response and its functional implications in the immune response after surgery in patients with chronic inflammation (clinical study)**

The connection between the surgery stress and the immune system has been presented in numerous publications and while many aspects of the subject have been discussed, most research has been devoted mainly to patients whose immune system works properly. In the available literature there is little information on the impact of the surgery stress on the immune system in patients with a chronic inflammation which in the light of the accepted hypothesis should contribute to the modulation of the immune system response to the surgery stress. Therefore it can be assumed that the development of the stress surgery response should be altered by abnormalities of immune system associated with chronic inflammation. The previous results had reported by author et al. partially helped to confirm the chronic inflammatory state ability to modify of the response of the immune system to surgery trauma (Lisowska et al., 2008). In view of the fact that many of earlier evaluated patients presented significant advanced chronic inflammatory process that reflected in the high activity disease being evaluated the Disease Activity Score-28 (DAS28) based European League Against Rheumatism (EULAR) response criteria (Fransen & van Riel, 2009). DAS28 seems to be correlated with severity of inflammation; therefore, the immune response to surgery was evaluated in the patients with the different disease activity.
