An increased risk of developing severe infections has been evidenced in rheumatic disease (RD) patients, and anti-COVID-19 vaccination is strictly recommended for RD patients. However, up to now, no data are available on safety, immunogenicity and efficacy of COVID-19 vaccinations in RD patients. The possible development of adverse events (AEs), including the flare-up of underlying RD, represents a matter of growing importance. The aim of our study is to assess, in RD patients, the safety profile of different types of approved vaccines and the possible influence of immunosuppressive therapies and clinical or demographic characteristics of RD patients on development of AEs. Participants (n = 185; 30.7%) received anti-COVID-19 vaccinations, 137 with autoimmune/chronic inflammatory RD (Au/cIn-RD) and 48 with nonautoimmune/chronic inflammatory RD (no-Au/cIn-RD). AEs were recorded in 42% of patients after the first dose of vaccine, and in 26% of patients after the second dose. The most common reported AEs after anti-COVID 19 vaccines were site injection pain (17%), headache (12%), fever (12%), myalgia (10%) and fatigue (10%). Relapses of the underlying Au/c-In-RD were recorded in 2.2% of patients after the first dose of vaccine. In Au/c-In-RD the risk of developing AEs after the first dose of vaccine was lower in older patients (OR = 0.95; p = 0.001), and in the group of patients with complete control of RD (OR: 0.2; p = 0.010). A lower percentage of AEs was observed in patients with complete control of their Au/cIn-RD (29%) compared to those with low (57%) or moderate-high disease activity (63%) (p = 0.002 and p = 0.006 respectively). In this study all types of COVID-19 vaccines in use in Italy seemed safe in RD patients. The results of this study might provide reassuring information for Au/cIn RD patients and clinicians and could strengthen the data on vaccine safety to guide the use of COVID-19 vaccines in Au/cIn-RD on immunosuppressive agents.

Background/Objectives: Even today, interstitial lung disease (ILD) is diagnosed by chest high-resolution computed tomography (lung HR-CT). Large amounts of data are available about the usefulness of transthoracic lung ultrasound (LUS) in ILD. This study aimed to evaluate the transthoracic LUS capacity to discriminate different ILD patterns in systemic sclerosis (SSc) patients, such as usual interstitial pneumonia (UIP), non-specific interstitial pneumonia (NSIP) with ground glass opacification/opacity (GGO), and NSIP with GGO and reticulations, as well as the possibility of identifying progressive fibrosing ILD. Methods: We enrolled SSc-patients attending the outpatient Clinic of the Rheumatology Unit of Policlinico of Foggia and the Rheumatology Unit of Policlinico of Bari who satisfied these inclusion criteria: age older than 18 years; the satisfaction of ACR/EULAR 2013 classification criteria for SSc; chest HR-CT scan within three months before or three months after transthoracic LUS evaluation; and availability of recent and complete pulmonary function test. The exclusion criteria were as follows: history or recent reactivation of chronic obstructive pulmonary disease, lung cancer, lung infection, heart failure, pulmonary oedema, pulmonary arterial hypertension, acute respiratory distress syndrome and diffuse alveolar haemorrhage and thoracic surgery. All enrolled SSc-patients underwent transthoracic LUS, performed by an experienced sonographer. The ILD diagnosis and the respective patterns were assessed by chest HR-CT, which still represents the best diagnostic tool. Results: ILD was observed in 99 (63.5%) patients. Of these, 25% had the UIP pattern and 75% the NSIP pattern (46 with GGO, 28 with GGO and reticulations). By receiver operating characteristic (ROC) curve analysis, higher values of accuracy, sensitivity, specificity, and negative clinical utility index (CUI) were found for pleural line irregularity (0.84 (95% CI: 0.75–0.91), 96%, and 73.6%, p = 0.0001; 0.72), and pleural line thickness (0.84 (95% CI: 0.74–0.91), 72%, and 96.4%, p = 0.0001; 0.85) for detecting the UIP pattern. The best performance among transthoracic LUS signs for NSIP with the GGO pattern was observed for B-lines (accuracy: 0.88 (95% CI: 0.80–0.93), sensitivity: 93.4% and specificity: 82.4, p = 0.0001; CUI+: 0.75, CUI−: 0.77). LUS signs with higher accuracy, sensitivity, and specificity for NSIP with GGO and reticulations were pleural line irregularity (0.89 (95% CI: 0.80–0.95), 96.4%, and 82.4%, p = 0.0001) with CUI−: 0.72, and B-lines (0.89 (95% CI: 0.80–0.95), 96.4%, 82.4%, p = 0.0001), with CUI+: 0.80 and CUI−: 0.70. Furthermore, a total number of B-lines > 10 maximises LUS performance with 92.3% sensitivity, and an accuracy of 0.83 (p = 0.0001) for detecting the NSIP pattern, particularly GGO. A sample-restricted analysis (66 SSc patients) evidenced the presence of progressive fibrosing ILD in 77% of these patients. By binary regression analysis, the unique LUS sign associated with progressive fibrosing ILD was the presence of pleural line irregularity (OR: 3.6; 95% CI 1.08–11.9; p = 0.036). Conclusions: Our study demonstrated that transthoracic LUS presented a high capacity to discriminate the different patterns of SSc-ILD. Therefore, the hypothesis that transthoracic LUS is an effective screening method for the evaluation of the presence of SSc-ILD and establishing the correct timing of chest HR-CT, in order to avoid patients receiving excessive exposure to ionising radiation, is supported.

In the clinical context of the new medical concept of diseases related to the Major Histocompatibility Complex class I (MHC-I-opathy), contrasting data are available on the possible association among HLA-B*51, Behcet’s disease (BD), and spondyloarthritis (SpA). The aim of this retrospective study on a cohort of HLA-B*51-positive patients who were clinically observed for almost 5 years is primarily to evaluate which classification criteria they satisfy among BD, axial (ax) or peripheral (p) SpA, and psoriatic arthritis (PsA). Furthermore, we characterized the possible impact of different arthritis phenotypes on the most frequent extra-articular clinical manifestations in BD, ax-SpA, p-SpA, and PsA. A comparison with HLA-B*51-negative patients (matched with HLA-B*51-positive patients for age, gender, and diagnosis, by mean propensity score) was also performed to evaluate the true impact on clinical manifestations of HLA-B*51. We conducted a monocentric retrospective study from 2013 to 2025. The inclusion criteria were HLA-B*51 positivity, the availability of the entire MHC-I class test, and rheumatological clinical follow-up of at least 5 years. The exclusion criterion was positivity for clinically important MCH-I loci other than HLA-B*51. A total of 105 patients met the inclusion criteria in an average clinical observation period of 8.4 ± 2.9 years. All patients were Apulian and were HLA-B* 51 positive. During the follow-up, 32 patients (31%) met the BD criteria, 17 (16%) met the PsA criteria, 25 (24%) met the p-SpA criteria, and 13 (12%) met the ax-SpA criteria. Of note, 16% and 34% of BD patients met the ax-SpA and p-SpA ASAS criteria, respectively. Prevalent articular phenotypes in this HLA-B*51 cluster of patients are a polyarticular pattern and enthesis involvement in all disease groups. In BD patients, axial involvement was associated with a significantly higher percentage of neurological manifestations (40% vs. 7%, p = 0.043) and inflammatory bowel disease (IBD) (100% vs. 15%, p = 0.0001), compared to patients with exclusive peripheral joint involvement. This latest data on IBD remains significant, even in comparison with HLA-B*51 negative patients (33%; p = 0.035). In the p-SpA group, a significantly higher rate of uveitis (28%) was observed compared to both ax-SpA with HLA-B*51-positive (0%, p = 0.035) and p-SpA with HLA-B*51-negative patients (4%, p = 0.030). A high percentage of multi-drug failures was highlighted in patients with PsA (60%) and p-SpA (40%). This study provides new data on the association between HLA-B*51 and the onset of BD and/or SpA or PsA, and its possible impact on extra-articular manifestations. We confirm the higher prevalence of the peripheral articular phenotype in BD, but we also highlight a specific association between the rarer axial involvement and gastrointestinal involvement in HLA-B*51 patients. In SpA, the peripheral articular phenotype appears to be associated with a higher occurrence of uveitis in the presence of HLA-B*51.

Background: Fibromyalgia syndrome (FS) is one of the most common causes of chronic generalised pain and often complicates the therapeutic management of inflammatory chronic arthritis (ICA), negatively impacting both the real assessment of disease activity and the perception of response. Our study aims to evaluate in a group of patients with ICA, multi-resistant to biologic/target synthetic disease-modifying antirheumatic drugs (b/ts-DMARDs), both the impact of FS on the possibility of achieving low disease activity (LDA) or remission (REM) and the possible improvement in the severity of FS symptoms, after starting b/ts-DMARDs with different a mechanism of action (MoA). Methods: A prospective study was conducted, from January 2023 to December 2024, on patients who fulfil the classification criteria for psoriatic arthritis (PsA) or fulfil the 2010 American College of Rheumatology criteria for RA. Results: Sixty-four Caucasian patients with ICA, of which 47 with FS, were enrolled in the study. At the baseline visit, FS patients had a significantly shorter ICA disease duration, worse fibromyalgia symptom-related indices (such as Fibromyalgia Severity Scale (FSS), Widespread Pain Index (WPI), and Symptom Severity Scale (SSS)) and functional and disability scores (such as health assessment questionnaire (HAQ) and Functional Assessment of Chronic Illness Therapy (FACIT)), and a higher basal value of Disease Activity in Psoriatic Arthritis (DAPSA) score compared to patients without FS. After 6 months of starting b/ts-DMARDs, no differences in severity of arthritis clinimetric indices (disease activity score (DAS) 28 (erythrocyte sedimentation (ESR)) and DAPSA) and Visual Analogue Scale (VAS) pain were found between the patients with FS compared to those without. At the follow-up visit, 36% of the whole group of patients were in LDA (36% ICA patients with FS vs. 35% of ICA patients without FS; p = 0.080), while 17% of patients reached REM (11% ICA with FS vs. 35% ICA without FS patients; p = 0.031). The FS presence appeared to be a factor associated with failure to reach REM (OR 4.5 (95%CI: 1.1–17.8), p = 0.028), but not for achieving LDA (OR 2.7 (95%CI: 0.8–8.9), p = 0.099). The overall retention rate at 6 months was 79%; in particular, 11 patients discontinued treatment with b/ts-DMARD, 69% of whom belonged to the FS group (p = 0.489). Among the group of patients with ICA and FS, patients in LDA/REM presented an important improvement in FSS, SSS, and VAS pain, with the best percentage variation from the baseline of these indices compared to patients who did not achieve the LDA/REM. Of note, sixteen patients with FS at the baseline no longer met the diagnostic criteria for FS after 6 months of follow-up. Conclusions: The presence of FS seems to negatively impact the achievement of REM, but not LDA, in both RA and PsA patients, even in b/ts-DMARDs patients with multi-failure of at least two different MOAs. Only a cluster of patients with FS, presumably those with FS triggered and/or amplified by the chronic joint inflammatory process, appear to improve their perception of FS severity by achieving ICA LDA/REM. However, these findings require further supporting data for more accurate validation.

Background/Objectives: Even today the interstitial lung disease (ILD) is diagnosed by chest high-resolution computed tomography (lung HR-CT). A large amount of data is available about the use-fulness of lung ultrasound (LUS) in ILD. The aim of this study is to evaluate the LUS capacity to discrim-inate different ILD patterns in systemic sclerosis (SSc) patients, such as UIP, NSIP with GGO, and NSIP with GGO and reticulations, and then the possibilityto identify the progressive fibrosing ILD. Methods: All SSc-patients with recent HRCT performed underwent LUS. Results: ILD was observed in 99 (63.5%) patients (25% with UIP pattern, and 75% with NSIP pattern (46 with GGO, 28 with GGO and reticula-tions). By ROC curve analysis, that higher accuracy, sensitivity, and specificity were found for pleural line irregularity (0.68, 95.8%, and 41.5%, p=0.004), pleural line thickness (0.72, 70.8%, and 73.2%, p=0.001), and subpleural cyst (0.68, 58.3%, and 78.9%, p=0.004) to detect UIP pattern. The best performance among LUS signs for NSIP with GGO pattern was observed for B-lines (accuracy: 0.73, sensitivity: 92.9% and specific-ity: 54.3, p=0.0001). LUS signs with higher accuracy, sensitivity, and specificity for NSIP with GGO and reticulations were pleural line irregularity (0.69, 96%, and 42.1%, p=0.002), pleural line thickness (0.69, 65.4%, 72.7%, p=0.002), and B-lines (0.72, 96.2%, 48.8%, p=0.0001). Furthermore, a total number of B-line > 10 maximises LUS performance with 92.3% sensitivity, and an accuracy of 0.83 (p=0.0001) to detect the NSIP pattern, particularly GGO. A sample-restricted analysis (66 SSc patients) evidenced the presence of progressive fibrosing ILD in 77%. By binary regression analysis, that the unique LUS sign associated with progressive fibrosing ILD was the presence of pleural line irregularity (OR: 3.6; 95% CI 1.08-11.9; p= 0.036). Conclusions: Our study demonstrated that the LUS presented a high capacity to discriminate the different patterns of SSc-ILD. Therefore, the hypothesis of using transthoracic LUS as a screening method for the evaluation of the presence of SSc-ILD and to establish the correct timing for the execution of chest HR-CT, in order to avoid patients from excessive exposure to ionising radiation is supported.