Mediterranean Journal of Rheumatology最新文献

{"title":"Cardiovascular Safety Signals of Osteoporosis Therapies: A FAERS Pharmacovigilance Study.","authors":"Manush Sondhi, Namrata Singh, Julie Carkin, Grant Hughes","doi":"10.31138/mjr.250126.psj","DOIUrl":"10.31138/mjr.250126.psj","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the associations between commonly used osteoporosis medications and major adverse cardiovascular events (MACE) using data from the Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS).</p><p><strong>Methods: </strong>We conducted a retrospective pharmacovigilance analysis of FAERS reports between January 2019 and December 2024, identifying all reports involving alendronate, risedronate, zoledronic acid, denosumab, teriparatide, abaloparatide, or romosozumab. MACE outcomes included myocardial infarction (MI), stroke, atrial fibrillation (A-fib), and cardiac failure (CF), defined using Medical Dictionary for Regulatory Activities Preferred Terms. Disproportionality was assessed using reporting odds ratios (RORs), with signals defined by a lower 95% confidence interval >1. All analyses were descriptive and hypothesis-generating.</p><p><strong>Results: </strong>FAERS contained more than 30 million adverse event reports during the study period. Romosozumab demonstrated the highest ROR for MI (2.38) and stroke (3.72), and also showed elevated signals for A-fib and CF (ROR 3.76). Zoledronic acid showed notable associations with stroke (ROR 2.42) and A-fib (ROR 3.22). Denosumab and abaloparatide were associated with the lowest RORs across all cardiovascular outcomes. Alendronate and risedronate demonstrated intermediate disproportionality signals, particularly for A-fib and CF.</p><p><strong>Conclusion: </strong>Romosozumab and zoledronic acid demonstrated prominent cardiovascular disproportionality signals in FAERS, whereas denosumab, abaloparatide, and teriparatide showed more favorable reporting profiles. These findings should not discourage osteoporosis treatment but underscore the importance of individualised cardiovascular risk assessment and the need for further prospective evaluation to inform safe therapy selection.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 3","pages":"598-602"},"PeriodicalIF":2.1,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arterial Stiffness and Early Vascular Damage in Ankylosing Spondylitis Regardless of Cardiovascular Risk Factors: A Cross-Sectional Study.","authors":"Miroslav Markov, Maria Dimova, Tsvetoslav Georgiev","doi":"10.31138/mjr.030226.rea","DOIUrl":"10.31138/mjr.030226.rea","url":null,"abstract":"<p><strong>Background: </strong>Our aim is to evaluate subclinical vascular damage in patients with ankylosing spondylitis using one-point echo-tracking-derived arterial stiffness indices and carotid intima-media thickness (CIMT), and to explore associations with inflammatory activity and traditional cardiovascular risk scores.</p><p><strong>Methods: </strong>This cross-sectional study included 83 patients with AS and 31 age- and sex-matched controls without inflammatory or cardiovascular disease. All participants underwent high-resolution ultrasound of the common carotid artery with one-point echo-tracking assessment of arterial stiffness parameters, including β-stiffness index, local pulse wave velocity (PWVβ), Peterson's elastic modulus (Ep), arterial compliance, and augmentation index, alongside CIMT measurement. Ten-year cardiovascular risk was estimated using the Framingham Risk Score and SCORE2.</p><p><strong>Results: </strong>Traditional cardiovascular risk estimates were comparable between groups (Framingham risk: 3.7 [2.0-7.5]% vs 5.25 [2.5-8.0]%, p = 0.378; SCORE2: 6.7 [3.5-10.5]% vs 7.3 [3.0-11.0]%, p = 0.718). In contrast, patients with AS demonstrated significantly increased arterial stiffness, with higher β-stiffness index (7.0 [5.4-8.6] vs 6.05 [5.2-6.9], p < 0.001), PWVβ (5.8 [5.2-6.5] vs 5.45 [4.9-5.9] m/s, p < 0.001), and Ep (90 [68-112] vs 78.5 [66-90] kPa, p < 0.001). CIMT did not differ significantly between groups. Body mass index independently predicted arterial stiffness (PWVβ standardized β = 0.41, p < 0.001).</p><p><strong>Conclusions: </strong>Ankylosing spondylitis is characterised by early functional vascular impairment despite preserved traditional cardiovascular risk profiles. One-point echo-tracking-derived arterial stiffness indices identify subclinical vascular damage beyond conventional risk assessment and may improve cardiovascular risk stratification in AS.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 3","pages":"542-549"},"PeriodicalIF":2.1,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unilateral Renal Artery Vasculitis: A Case Report.","authors":"Iraklis Lefas, Pinelopi Konstantopoulou","doi":"10.31138/mjr.230126.ral","DOIUrl":"10.31138/mjr.230126.ral","url":null,"abstract":"<p><p>Renal artery inflammation is typically observed as part of systemic vasculitis rather than as an isolated condition. Large vessel vasculitides, such as Takayasu arteritis and giant cell arteritis, as well as polyarteritis nodosa, may involve multiple vessels, including the renal artery. Isolated vasculitis of the renal artery is exceedingly rare with only eight cases reported worldwide. We describe a case of a previously healthy 53-year-old man who presented with a history of right flank pain which was attributed to renal artery vasculitis. Extensive radiologic studies revealed no evidence of inflammation in other vessels and laboratory evaluation for an underlying infectious, neoplastic or autoimmune cause was negative. Treatment with methylprednisolone, followed by azathioprine as a steroid-sparing agent, led to complete remission of the condition.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 3","pages":"615-618"},"PeriodicalIF":2.1,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Pitfall: Prolonged COVID-19 Presenting as Organising Pneumonia in a Rituximab-Treated Patient with Rheumatoid Arthritis.","authors":"Antigoni Soufla, George E Fragoulis, Alexios Iliopoulos","doi":"10.31138/mjr.090326.rpr","DOIUrl":"10.31138/mjr.090326.rpr","url":null,"abstract":"<p><p>Rituximab (RTX)-induced B-cell depletion is associated with prolonged SARS-CoV-2 infection. We describe a case of persistent COVID-19 in a patient with rheumatoid arthritis (RA) initially misdiagnosed as cryptogenic organising pneumonia (COP), highlighting the diagnostic and management challenges in RTX-treated patients. Retreatment with a second 5-day course of nirmatrelvir/ritonavir led to rapid clinical improvement and complete radiological resolution. Persistent SARS-CoV-2 infection should be considered in RTX-treated patients with non-resolving pulmonary infiltrates, particularly when corticosteroid therapy is ineffective.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 3","pages":"619-621"},"PeriodicalIF":2.1,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Gut Microbiota in Rheumatoid Arthritis: Evaluation of Microbial Profiles, Disease Activity, Biomarkers, and Treatment Response.","authors":"Danai C Theiopoulou, Dimitrios Vassilopoulos, Clio P Mavragani, George Bertsias","doi":"10.31138/mjr.160825.emr","DOIUrl":"10.31138/mjr.160825.emr","url":null,"abstract":"<p><strong>Objectives: </strong>Rheumatoid arthritis (RA) is a chronic autoimmune disease with complex etiopathogenesis, and variable clinical course. The human gastrointestinal (GI) tract is a dynamic ecosystem in which micro-organisms influence metabolism, immune signalling, and pathogen resistance. Understanding these interactions is key to exploring the microbiota's role in RA. This review examines how intestinal and oral microbiota differ in RA patients and influence disease activity and treatment response.</p><p><strong>Method: </strong>A literature search was conducted using PubMed, from inception until January 3, 2025. Studies were selected based on the inclusion of original research involving human subjects diagnosed with RA. Exclusion criteria comprised reviews, case reports, animal studies, and studies with insufficient data. Of the 329 records identified, 72 were included in this review.</p><p><strong>Results: </strong>Most studies have implicated changes in bacterial composition involving specific phyla in RA-associated dysbiosis. The imbalance is primarily driven by alterations in the phyla <i>Bacillota</i>, <i>Pseudomonadota</i>, and <i>Bacteroidota</i>, with <i>Bacillota</i> and <i>Pseudomonadota</i> accounting for 70% of increased taxa, and <i>Bacillota</i> and <i>Bacteroidota</i> for 83% of decreased intestinal taxa. Other findings include reduced α-diversity in seronegative patients and associations between decreased <i>Prevotella</i> taxa and higher disease activity, inflammation biomarkers, and autoantibodies. Smaller studies have also reported elevated serum zonulin-a marker of intestinal permeability-in RF-positive patients.</p><p><strong>Conclusion: </strong>This review highlights key bacterial phyla linked to RA and emphasises the potential of probing gut micro-biota-immune system interactions to improve diagnosis and treatment.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 3","pages":"469-480"},"PeriodicalIF":2.1,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Safety of Recombinant Zoster Vaccine on Patients with Systemic Lupus Erythematosus in a Tertiary Hospital in Saudi Arabia: A Retrospective Single Centre Study.","authors":"Hoda Draz, Nada Ibrahim, Ibrahim Al-Homood, Assia S Alwabel","doi":"10.31138/mjr.140126.sqy","DOIUrl":"10.31138/mjr.140126.sqy","url":null,"abstract":"<p><strong>Introduction: </strong>Herpes Zoster (HZ) infection is more severe in patients with Systemic lupus erythematosus (SLE). Recent guidelines recommend the Recombinant Zoster Vaccine (RZV) for prevention of HZ in immunocompromised adults aged ≥18 years. RZV has demonstrated efficacy against HZ infection in immunocompromised populations, but data regarding its safety among SLE patients are lacking, especially those who are on biological therapy.</p><p><strong>Objective: </strong>Evaluation of the safety of RZV among SLE patients, including patients on biological therapy.</p><p><strong>Method: </strong>A retrospective study of 170 patients with SLE who received at least one dose of RZV and 45 unvaccinated SLE patients were included. Data were extracted from the King Fahad Medical City (KFMC) hospital database system. Data analysis was carried out using Statistical methods.</p><p><strong>Results: </strong>A study involved 170 SLE patients who received RZV (90.6% females, with a mean age of 38.5 years and an SLE duration of 8.5±6.2 years). Seventy percent completed two doses of RZV. The mean baseline, post-first-dose, and post-second-dose SLEDAI scores were 3.43±5.27, 3.31±3.11, and 2.97±2.78, respectively, indicating no significant change. A subset of patients was treated with biological therapies, including Belimumab, Rituximab, and Anifrolumab. The incidence of SLE flare within 90 days was 12.9% after the first dose and 12.3% after the second dose. There was a statistically significant association between higher baseline SLEDAI scores and flares after both doses.</p><p><strong>Conclusion: </strong>Vaccination with RZV in patients with SLE is safe and not associated with increased SLE activity which is comparable with unvaccinated patients. The reported side effects were mild and comparable to those of the general population.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 3","pages":"575-580"},"PeriodicalIF":2.1,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rheumatoid Arthritis-Associated Interstitial Lung Disease Mortality Trends in the United States: A Population-Based Analysis (1999-2020).","authors":"Farheen Malik, Jawad Ahmed, Mandar Shah, Ritika Uttam, Muhammad Fahimuddin","doi":"10.31138/mjr.061225.ldt","DOIUrl":"10.31138/mjr.061225.ldt","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate long term trends and demographic, racial, and geographic disparities in mortality related to rheumatoid arthritis associated interstitial lung disease (RA-ILD) in the United States from 1999 to 2020.</p><p><strong>Methods: </strong>Mortality data were taken from the CDC WONDER Multiple Cause of Death database for individuals aged 15 and older. Deaths were included if both ICD-10 codes for rheumatoid arthritis (M05-M06) and interstitial lung disease with fibrosis (J84.1) were recorded; juvenile RA (M08.0) was excluded. Age-adjusted mortality rates (AAMRs) per 100,000 individuals were computed using the 2000 U.S. standard population. Trends were analysed through average and segmented annual percent changes (AAPC, APC) by sex, age, race/ethnicity, geography, and rural urban classification.</p><p><strong>Results: </strong>Between 1999 and 2020, there were 10,171 RA-ILD related deaths. The overall AAMR was 0.2 per 100,000, declining from 0.2 in 1999 to 0.1 in 2020 (AAPC -3.08; 95% CI -4.79 to -2.28; p<0.01). Females represented 63.5% of deaths, exhibiting higher AAMRs than males (0.2 versus 0.1). American Indian/Alaska Native individuals had the highest mortality rate (0.5), while non-Hispanic Black and Asian/Pacific Islander groups had the lowest (0.1). The most significant decline occurred from 2014 to 2017 (APC -24.09; p<0.05). Geographic disparities persisted, especially in northern and western states.</p><p><strong>Conclusion: </strong>Mortality from RA-ILD has decreased over the past two decades, particularly post 2014, likely due to enhanced management and early detection of ILD. However, ongoing gender, racial, and regional disparities emphasise the necessity for equitable healthcare access.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 3","pages":"557-561"},"PeriodicalIF":2.1,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaccines for Autoimmune Diseases: Stopping Triggers, Restoring BalanceA Systematic Review with Qualitative Synthesis.","authors":"Jozélio Freire de Carvalho, Cezar Augusto Muniz Caldas, Yehuda Shoenfeld","doi":"10.31138/mjr.111225.rba","DOIUrl":"10.31138/mjr.111225.rba","url":null,"abstract":"<p><strong>Objective: </strong>To critically review the scientific background on vaccines designed to prevent autoimmune diseases, including two main strategies: (1) vaccines directed against pathogens involved in triggering disease, including Epstein-Barr virus (EBV), enterovirus and Streptococcus pyogenes; and (2) tolerogenic vaccine approaches targeting the immune response to restore tolerance to self-antigens.</p><p><strong>Methods: </strong>We performed a thorough systematic review of clinical trials, observational studies, meta-analysis and pre-clinical data. A broad search was implemented in biomedical databases and gray literature. This systematic review was conducted with qualitative synthesis, given the heterogeneity of study designs, diseases, and outcomes. Two reviewers independently selected studies for inclusion and extracted data, using standard risk of bias and quality of evidence assessment tools.</p><p><strong>Results: </strong>There were 68 studies, 36 in humans and 32 preclinical studies included. In the anti-infective area, options include gp350 vaccine for EBV (phase 2), mRNA based early-stage vaccines, a population-based study of the impact of rotavirus vaccination on type 1 diabetes incidence, and inactivated PRV-101 Coxsackie B strain vaccine; for rheumatic fever, phase 1 trials are providing evidence with vaccines such as StreptAnova and J8/S2. With regard to the tolerogenic line, tolerogenic DC-based and of myelin peptides vaccines have shown immune regulation in illnesses such as MS and RA, but do not yet demonstrate solid clinical evidence.</p><p><strong>Conclusions: </strong>Trigger infections vaccines are now nearing clinical use whereas tolerogenic vaccines constitute an attractive approach for the future. The combination of these approaches has the potential to inform future preventive and therapeutic strategies, but current evidence remains heterogeneous and largely early-stage, particularly for tolerogenic platforms.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 3","pages":"490-497"},"PeriodicalIF":2.1,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CAR T-Cell Therapy in Systemic Lupus Erythematosus: Mechanistic Rationale, Early Clinical Experience, and Future Challenges.","authors":"Sabarinath Mahadevan, Saranya Chinnadurai, Balakrishnan Navaneethakrishnan","doi":"10.31138/mjr.171125.mer","DOIUrl":"10.31138/mjr.171125.mer","url":null,"abstract":"<p><p>Systemic lupus erythematosus (SLE) remains a challenging multisystem autoimmune disease characterised by relapses and remissions, often necessitating lifelong immunosuppression. Over the past decades, the therapeutic landscape has evolved from broad-spectrum agents such as cyclophosphamide to more targeted biologics including rituximab, belimumab, and anifrolumab-each contributing to incremental improvements in disease control. More recently, cell-based therapies have emerged as a novel strategy to reprogramme immune responses, including haematopoietic stem cell transplantation, bispecific T-cell engager (BiTE) therapy, and chimeric antigen receptor (CAR) T-cell therapy. CAR T-cell therapy represents a potentially transformative approach in SLE, offering the prospect of sustained clinical and immunological remission without ongoing immunosuppression. In this narrative review, we searched the Medline/PubMed, Scopus, Web of Science, and Directory of Open Access Journals (DOAJ) and included relevant original articles, clinical trials, randomised controlled trials, case studies and case reports published in the last 7 years. In this review, we discuss the mechanistic rationale for CAR T-cell therapy in SLE, review the clinical outcomes reported to date, and explore its promise in ushering a new era of durable, drug-free remission in autoimmune disease.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 3","pages":"506-513"},"PeriodicalIF":2.1,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of the Angiotensin-Converting Enzyme Insertion/Deletion Polymorphism with Increased Susceptibility to Vasculitis: A Systematic Review and Meta-Analysis.","authors":"Praveen Kumar Chandra Sekar, Ramakrishnan Veerabathiran","doi":"10.31138/mjr.111125.isv","DOIUrl":"10.31138/mjr.111125.isv","url":null,"abstract":"<p><strong>Objective: </strong>This meta-analysis aimed to evaluate the association between the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism and susceptibility to vasculitis, including Henoch- Schönlein purpura (HSP), Henoch-Schönlein purpura nephritis (HSPN), and Behçet's disease (BD).</p><p><strong>Methods: </strong>Relevant studies were systematically retrieved from PubMed, Embase, and Google Scholar until November 2025. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using different genetic models. Heterogeneity was assessed using the Cochrane Q test and I² statistics, and random-effects models were applied. Statistical analyses were performed using the Review Manager (version 5.4).</p><p><strong>Results: </strong>Fifteen eligible studies, including five on HSP, four on HSPN, and six on BD, were included, with a total of 1,536 cases and 1,947 controls. Pooled analysis demonstrated a significant association between the ACE I/D polymorphism and an increased risk of vasculitis (D vs. I, OR = 1.42, 95% CI 1.15-1.76), with stronger associations observed in Caucasian populations. Subgroup analysis revealed that the D allele was significantly associated with higher susceptibility to HSP and BD, whereas a modest association was detected for HSPN in the allelic comparison model.</p><p><strong>Conclusion: </strong>The findings suggest that the ACE D allele may be a genetic risk factor for vasculitic disorders, especially HSP and BD, supporting the possible involvement of the renin-angiotensin system in the development of autoimmune vascular inflammation.</p>","PeriodicalId":32816,"journal":{"name":"Mediterranean Journal of Rheumatology","volume":"37 3","pages":"445-456"},"PeriodicalIF":2.1,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}