Clinical Rheumatology最新文献

{"title":"Neutrophil extracellular trap suppression in rheumatoid arthritis patients treated with biologic therapy: a prospective observational study.","authors":"Georgios V Papamichail, Akrivi Chrysanthopoulou, Nikolaos A Georgiadis, Christina A Kapsali, Vasileios G Xydis, Athanasios Kitsakos, Alexandros A Drosos, Paraskevi V Voulgari","doi":"10.1007/s10067-026-08454-8","DOIUrl":"https://doi.org/10.1007/s10067-026-08454-8","url":null,"abstract":"<p><strong>Background: </strong>Rheumatoid arthritis (RA) is associated with increased cardiovascular risk, partly driven by chronic systemic inflammation. Neutrophil extracellular traps (NETs) have emerged as important mechanistic links between sustained immune activation and early vascular injury.</p><p><strong>Objective: </strong>To evaluate changes in NET-associated activity following initiation of biologic therapy in patients with RA and to investigate the relationship between treatment- associated changes in NETs, lipid profile, and subclinical atherosclerosis.</p><p><strong>Methods: </strong>In this prospective single-arm observational study, 36 patients with RA initiating biologic therapy were evaluated at baseline and after 6 months of treatment. Disease activity was assessed using DAS28-CRP, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Circulating citrullinated histone H3 (CitH3) levels were measured by ELISA as a robust marker of NETs. Carotid intima-media thickness (cIMT) was assessed using high-resolution B-mode ultrasonography. Linear regression analyses were performed to investigate the relationship between NETs activity, inflammatory burden, lipid profile, and subclinical atherosclerosis, both cross-sectionally and longitudinally following biologic therapy.</p><p><strong>Results: </strong>Following initiation of biologic therapy, disease activity and inflammatory markers improved significantly. Circulating CitH3 levels decreased from a median 3.89 (0.11-32.78) to 2.56 (0.07-8.39; p-value 0.025) while cIMT decreased from a median 1 (0.7-1.6) mm to 0.75 (0.6-1.3 mm; p-value < 0.001) after 6 months of treatment. HDL cholesterol increased significantly from 56.36 ± 16.21 to 67.47 ± 17.56 mg/dL (p < 0.001). At follow-up, CitH3 levels were independently associated with ESR (β = 0.448, p = 0.018), indicating a relationship between NETs and systemic inflammatory burden. Longitudinal analyses demonstrated that changes in HDL cholesterol were independently associated with changes in CitH3 (β =  - 0.505, p = 0.003), whereas changes in DAS28, CRP, ESR, oxLDL, and cIMT were not independently associated with ΔCitH3. No significant differences in ΔCitH3 were observed between anti-TNF and non-anti-TNF therapies.</p><p><strong>Conclusions: </strong>In this prospective observational cohort, initiation of biologic therapy was associated with reduced circulating CitH3 levels, alongside improvements in disease activity, inflammatory markers, HDL cholesterol, and cIMT. The longitudinal association between increases in HDL cholesterol and reductions in CitH3 was independent of changes in disease activity and cIMT, generating a hypothesis regarding a potential immunometabolic relationship between HDL cholesterol and NET-associated activity. These findings should be considered exploratory and require confirmation in larger, controlled prospective studies. Key Points • Biologic therapy was associated with a significant reduction in c","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on \"Real-world effectiveness and safety of apremilast in psoriatic arthritis: results from the multicenter Italian MAPSI II study\".","authors":"Alarico Ariani, Simone Parisi, Marino Paroli, Andrea Becciolini","doi":"10.1007/s10067-026-08435-x","DOIUrl":"https://doi.org/10.1007/s10067-026-08435-x","url":null,"abstract":"","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduced serum Irisin levels in systemic sclerosis: a cross-sectional case-control study.","authors":"Burak Okyar, Alper Yıldırım, Berkay Eyi, Okan Dilek, Hikmet Eda Alışkan, Hilmi Erdem Sümbül, Emine Duygu Ersözlü","doi":"10.1007/s10067-026-08457-5","DOIUrl":"https://doi.org/10.1007/s10067-026-08457-5","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Irisin is a muscle-derived myokine implicated in metabolic regulation, endothelial function, inflammation, and fibrotic remodeling. Its relevance in systemic sclerosis (SSc), a disease characterized by autoimmunity, vasculopathy, and fibrosis, remains unknown. To compare serum Irisin levels between patients with SSc and healthy controls and to evaluate their associations with clinical-serological phenotype and organ-domain involvement in SSc.</p><p><strong>Methods: </strong>This single-center cross-sectional case-control study included 52 patients with SSc and 47 healthy controls. Serum Irisin was measured by ELISA. Clinical-serological subsets, nailfold videocapillaroscopy findings, modified Rodnan skin score, pulmonary function, HRCT-derived ILD and Warrick scores, echocardiographic variables, gastrointestinal involvement, comorbidities, treatment exposure, and laboratory parameters were assessed. Adjusted analyses used log-linear models with robust standard errors.</p><p><strong>Results: </strong>Serum Irisin levels were significantly lower in SSc patients than in controls [696.70 pg/mL, IQR 611.16-1288.50 vs. 755.84 pg/mL, IQR 689.34-1899.75; p = 0.004]. This association remained significant after adjustment for age, sex, BMI, and smoking status, corresponding to 23.8% lower Irisin levels in SSc. Exploratory within-SSc analyses suggested lower Irisin levels in diffuse SSc and Scl-70-positive disease, particularly in adjusted models; however, unadjusted subgroup comparisons were weaker and should be interpreted cautiously. Irisin was not associated with NVC damage burden, mRSS, ILD severity, pulmonary function, or echocardiographic variables.</p><p><strong>Conclusion: </strong>Serum Irisin levels are reduced in patients with SSc compared with healthy controls. Exploratory phenotype analyses suggest a possible association with diffuse/Scl-70-related disease, but this signal requires confirmation in independent cohorts. Irisin did not reflect established organ-domain damage, suggesting that it may represent a broader myokine-metabolic alteration in SSc rather than a direct organ severity biomarker. Key Points • Serum Irisin levels were lower in patients with systemic sclerosis than in healthy controls. • Exploratory phenotype analyses suggested lower Irisin levels in diffuse and Scl-70-positive SSc, but these subgroup findings require cautious interpretation. • Serum Irisin was not associated with NVC damage, skin score, ILD severity, pulmonary function, or echocardiographic variables.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound viscoelasticity and attenuation imaging for rheumatoid arthritis-associated muscle quality changes: a clinical transcriptomic study.","authors":"Zhi Zheng, YuNong Han, XiaoLei Tang, LinLi Zhu, Yong He, Feng Wang, YiQing Zhan, WeiBo Cheng","doi":"10.1007/s10067-026-08339-w","DOIUrl":"10.1007/s10067-026-08339-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Rheumatoid arthritis (RA) is associated with loss of muscle quality and strength, but accessible quantitative tools for detecting these changes remain limited. We evaluated whether shear wave viscoelastic imaging (SWVI), acoustic attenuation imaging (AAI), and isokinetic strength testing could characterize rectus femoris muscle involvement in RA, and used public synovial transcriptomic data to provide hypothesis-generating biological context.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Twenty-nine patients with RA (early RA, n = 7; active RA, n = 11; treated low/moderate-activity RA, n = 11) and 27 healthy controls underwent rectus femoris ultrasound and knee isokinetic strength testing. The main ultrasound variables were rectus femoris thickness and cross-sectional area, mean Young's modulus (Emean), viscosity (Vimean), speed of sound (SoS), and AAI. Group differences, Spearman correlations, receiver-operating-characteristic (ROC) curves, and exploratory logistic models were analyzed. Because the RA cohort was small and diabetes was more common in RA than in controls, ROC, nomogram, and multivariable results were interpreted as exploratory rather than confirmatory. Public GSE55235 synovial transcriptome data were reanalyzed to identify inflammatory and extracellular-matrix pathways that may plausibly link synovitis with systemic muscle impairment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Rectus femoris thickness and cross-sectional area showed limited between-group separation, whereas Emean, Vimean, SoS, AAI, and isokinetic strength differed across groups (all p &lt; 0.001). AAI increased from controls to early, active, and treated low/moderate-activity RA groups and correlated with disease duration in the full cohort (Spearman rho = 0.864); this association remained strong in RA-only adjusted sensitivity analyses. SoS decreased across the same gradient (rho =  - 0.875 with duration in the full cohort), whereas Vimean was highest in active RA and correlated with DAS28 in the full cohort (rho = 0.643). Extensor peak torque was lower in RA and correlated inversely with DAS28 in the full cohort (rho =  - 0.844); the corresponding RA-only association was more moderate but remained significant (rho =  - 0.642). In exploratory ROC analyses, AAI, SoS, and extensor peak torque showed high apparent discrimination between RA and controls; however, the small overall and subgroup samples, baseline differences in diabetes and height, and absence of external validation make these estimates potentially unstable and preclude conclusions about clinical applicability. Synovial transcriptomic analysis showed enrichment of TNF, NF-κB, JAK-STAT, cytokine-receptor, and extracellular-matrix remodeling pathways in RA synovium, supporting a plausible inflammatory background rather than direct evidence of muscle pathology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In this exploratory clinical-transcriptomic study, SWVI/AAI and isokinetic strength testing detected rectus","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"6033-6049"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of extra-articular manifestations in seronegative and seropositive rheumatoid arthritis patients: a 6-year retrospective study in a tertiary care center.","authors":"Hajar Alhusani, Marcel Katrib, Ghassan Farhat, Mira Merashli","doi":"10.1007/s10067-026-08326-1","DOIUrl":"10.1007/s10067-026-08326-1","url":null,"abstract":"<p><strong>Objective: </strong>Extra-articular manifestations in rheumatoid arthritis (RA) are associated with poorer prognosis and reduced quality of life. However, these manifestations have been far more studied in seropositive than in seronegative RA, particularly in the MENA region. This study aims to examine and compare the prevalence and types of extra-articular manifestations in seropositive versus seronegative RA.</p><p><strong>Methods: </strong>Retrospective cohort study conducted at the American University of Beirut Medical Center (2018-2024). The target population consists of patients with RA, whether seropositive or seronegative, diagnosed based on the 2010 (ACR) classification criteria. Comparison between groups was performed using chi-square and T test; Pearson's correlation coefficient (r) was utilized for correlation analyses, and ANOVA was used to compare group means.</p><p><strong>Results: </strong>Among 634 patients with RA, 282 (44.9%) had extra-articular manifestations. Of these, 210 (74.5%) were seropositive, and 72 (25.5%) were seronegative. Notably, upon examining the serological groups, the prevalence of ExRA was 49.3% among seronegative patients compared to 43.03% among seropositive patients. Baseline characteristics were similar between seropositive and seronegative RA groups in age (mean 51 ± 11), sex (83-89% female), smoking status, BMI, and age at diagnosis, with seropositive patients having longer disease duration (p < 0.001). Fibromyalgia was more common in seronegative RA (25% vs 12%, p = 0.008), while osteoarthritis was more frequent in seropositive RA (10% vs 1.4%, p = 0.019). Most patients (≈90%) had 1-2 extra-articular features. Anemia (54.3%) and sicca syndrome (41.1%) were the most prevalent. Nearly all patients received conventional DMARDs, while biologics and advanced therapies were more frequently used in seropositive RA.</p><p><strong>Conclusion: </strong>Seronegative RA patients showed distinct patterns in both extra-articular features, comorbidities profiles, and treatment approach. Extra-articular manifestations were slightly more common in seronegative patients, suggesting that this subgroup may still carry a relevant systemic burden. Unlike most prior studies that examined serostatus among patients with extra-articular disease, our study assessed the prevalence of these manifestations within each serological category. Key Points • Sicca symptoms, Raynaud's phenomenon, and osteoporosis were significantly more common in seronegative RA. • Anemia and sicca symptoms were the most common extra-articular manifestations. • Biologic and advanced therapies were more frequently used in seropositive RA, likely reflecting greater systemic severity.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"6023-6032"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and transient impact of childhood abuse and neglect on health-related quality of life in Mexican patients with early rheumatoid arthritis.","authors":"Guillermo Guaracha-Basáñez, Irazú Contreras-Yáñez, Abril Verónica Mendoza-Vigueras, Frida Carvajal-Medina, Ana Belén Ortiz-Haro, Loraine Ledón-Llanes, Virginia Pascual-Ramos","doi":"10.1007/s10067-026-08370-x","DOIUrl":"10.1007/s10067-026-08370-x","url":null,"abstract":"<p><strong>Introduction: </strong>Adverse childhood experiences are risk factors for rheumatic diseases outcomes. Prospective studies from low- and middle-income countries remain limited. This study aimed to estimate the prevalence of childhood abuse and neglect (CAN) in Mexican patients with recent-onset rheumatoid arthritis (RA) and to evaluate its impact on outcomes during the first year of follow-up.</p><p><strong>Patients and methods: </strong>This nested cross-sectional study was conducted within an ongoing prospective cohort initiated in 2004, with data collected from June to December 2025. Clinical, laboratory, and patient-reported outcomes were collected throughout patient follow-up. In 2025, CAN was introduced as a key outcome, assessed and defined by self-report and using a locally developed and validated 29-item scale encompassing six dimensions. Raw scores for each of the eight SF-36 domains were determined. The area under the curve was calculated for each cumulative outcome. Adjusted linear regression models were used to evaluate the association between CAN and outcomes scores.</p><p><strong>Results: </strong>Among 156 patients, 41 (26.3%) met criteria for CAN. CAN was significantly associated with lower scores in the physical functioning, role-physical, social functioning, and pain domains of the SF-36. CAN did not have a significant impact on other baseline outcomes. High baseline disease activity impacted all the SF-36 domains. The impact of CAN on cumulative SF-36 domain scores was no longer observed early during follow-up.</p><p><strong>Conclusions: </strong>CAN was reported by one in four Mexican patients in an early RA cohort, and was associated with a significant, albeit temporary, reduction in some dimensions of health-related quality of life. Keypoints • Childhood abuse or neglect was reported by 26.3% of patients with recent-onset rheumatoid arthritis. • Childhood abuse or neglect and high baseline disease activity were associated with poorer first-year health-related quality of life. • The negative impact of childhood abuse or neglect on health-related quality of life was no longer evident after 2 months of early treatment.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"6091-6102"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health equity in rheumatology-the uneven landscape of cellular therapy.","authors":"Sharon Dowell, Grace C Wright","doi":"10.1007/s10067-026-08367-6","DOIUrl":"10.1007/s10067-026-08367-6","url":null,"abstract":"<p><p>Cellular therapies may effectively \"reset\" the immune system and fundamentally alter the long-term course of chronic autoimmune rheumatic diseases. Clinical application in systemic lupus erythematosus resulting in drug-free remission has driven inquiry into other rheumatic disorders-systemic sclerosis, inflammatory myositis, Sjogren's disease-with early signals of significant therapeutic response. The substantial costs, complex manufacturing processes, and need for intensive patient monitoring limit cellular therapy delivery to certified academic centers-making it out of reach for many patients. The promise of remarkable therapeutic advances is therefore countered by the risk of deepening existing inequities, with limited access fueled by cost and compounded by the complexity of treatment. In this editorial, we argue that this early phase of cellular therapy in rheumatology presents a critical window for rheumatologists, trialists, industry partners and policymakers to embed equity into trial design, access frameworks and reimbursement pathways.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"5957-5961"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MiR‑365b‑5p and MiR‑3614‑5p are elevated in PBMCs of systemic lupus erythematosus and exhibit potential as complementary diagnostic indicators.","authors":"Ya Gong, Jing Hu, Kaihong Luo, Bin Yang, Zhenzhen Su","doi":"10.1007/s10067-026-08364-9","DOIUrl":"10.1007/s10067-026-08364-9","url":null,"abstract":"<p><strong>Introduction: </strong>Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disorder lacking ideal early diagnostic biomarkers. This study aimed to identify and validate novel microRNAs (miRNAs) in peripheral blood mononuclear cells (PBMCs) as diagnostic biomarkers for SLE.</p><p><strong>Methods: </strong>This study comprised a screening stage and a validation stage. We performed high-throughput miRNA sequencing in 3 SLE patients and 3 healthy controls, then validated candidate miRNAs in 39 SLE patients and 40 healthy controls using quantitative real-time polymerase chain reaction (qPCR). Diagnostic performance was assessed using receiver operating characteristic (ROC) curves, and correlations with clinical indicators were analysed.</p><p><strong>Results: </strong>Seventy-eight differentially expressed miRNAs were identified in SLE. Among them, miR-365b-5p and miR-3614-5p were significantly upregulated in SLE PBMCs (both P<0.001). ROC analysis showed area under the curve (AUC) values of 0.733 and 0.782 for the individual models and 0.805 for the combination. MiR-365b-5p was positively correlated with IgM, while miR-3614-5p was associated with immune cell counts, liver and kidney function, and metabolic parameters. Bioinformatics suggested involvement in immune regulation and the MAPK signaling pathway.</p><p><strong>Conclusions: </strong>miR-365b-5p and miR-3614-5p are significantly elevated in SLE and have favourable diagnostic value. These two miRNAs may serve as complementary diagnostic biomarkers that could facilitate early detection, differential diagnosis, and the elucidation of immune pathogenesis in SLE. Key Points • MiR‑365b‑5p and miR‑3614‑5p were significantly upregulated in SLE PBMCs. • MiR‑365b‑5p and miR‑3614‑5p may serve as novel diagnostic biomarkers for SLE and contribute to its pathogenesis via immune regulation and the MAPK signaling pathway.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"6127-6142"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late-onset versus young-onset rheumatoid arthritis in South Africans.","authors":"Marna Pawson, Lai-Ling Winchow, Mohammed Tikly, Nimmisha Govind","doi":"10.1007/s10067-026-08338-x","DOIUrl":"10.1007/s10067-026-08338-x","url":null,"abstract":"","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"5951-5956"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 outcomes among vaccinated and unvaccinated patients receiving disease-modifying antirheumatic drugs and biologic therapies: a retrospective multihospital cohort study.","authors":"Dat Le, Yijin Wert","doi":"10.1007/s10067-026-08371-w","DOIUrl":"10.1007/s10067-026-08371-w","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Patients receiving disease-modifying antirheumatic drugs (DMARDs) and biologic therapies were underrepresented in initial COVID-19 vaccine trials, limiting understanding of vaccine effectiveness in immunosuppressed populations. While immunogenicity studies demonstrate reduced antibody, real-world outcome-based evidence remains limited. We evaluated the association between COVID-19 vaccination and clinical outcomes among hospitalized patients receiving systemic DMARDs and biologic therapies.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study across seven hospitals within the UPMC health system in Central Pennsylvania. Adults (≥ 18 years) hospitalized with COVID-19 between March 2020 and April 2025 and receiving immunomodulatory therapy. Vaccination status was determined using electronic health records and registry-linked coding data, with vaccine type and SARS-CoV-2 variants also assessed. The primary outcome was hospital length of stay (LOS). The secondary outcome was in-hospital mortality. Multivariable logistic regression and gamma regression models adjusted for key demographic and clinical covariates.</p><p><strong>Results: </strong>Among 254 patients, 144 were vaccinated and 110 were unvaccinated. One hundred twenty-eight vaccinated patients received at least one booster. Vaccinated had shorter median LOS (6 vs. 10 days; p < 0.0001), with a 37% reduction in LOS odds. Among vaccinated, those who received at least 1 booster had shorter LOS than those without a booster (6 vs. 7.5 days; p = 0.0414). In-hospital mortality was lower among vaccinated (6.25% vs. 27.27%; p < 0.0001), with an 84% reduction in odds of death (adjusted OR, 0.157; 95% CI, 0.068-0.361).</p><p><strong>Conclusion: </strong>Among hospitalized receiving DMARDs and biologic therapies, COVID-19 vaccination was independently associated with reduced mortality and shorter hospital length of stay, supporting vaccination as a critical protective strategy in immunosuppressed populations. Key Points • COVID-19 vaccination was independently associated with a 37% reduction in hospital length of stay among immunosuppressed patients receiving DMARDs or biologics. • Vaccinated patients experienced substantially lower in-hospital mortality (6.25% vs 27.27%), even after adjustment for clinical covariates. • Vaccination was associated with an 87% reduction in adjusted odds of death. • Findings support COVID-19 vaccination as protective in patients receiving DMARDs and biologic therapies.</p>","PeriodicalId":10482,"journal":{"name":"Clinical Rheumatology","volume":" ","pages":"5989-5997"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}