**6. Conclusion and future research**

Data on the dynamic changes of postoperative serum concentration of tested cytokines revealed the impairment response of the immune system to surgical stress, regardless of the intensity of disease activity.

Together, the evidence presented above suggests that it may be possible to identify patients likely to develop a more intensive problems with wound healing and postoperative complications. In conclusion the abnormal immune system with chronic inflammatory process due to autoimmune disease can attenuate the cytokines response to surgery.

The future experiments has to be enlarged on the other immunological response factors evaluations including endothelial dysfunction factors. The chronic inflammatory response influence on the wound healing process has to be evaluate in details. Thus, the major role of the growth factors while fibroblastic proliferation reactions as the key pathogenic factor during rheumatoid arthritis has to be initially evaluated.
