COVID-19 vaccines are of great importance in reducing SARS-CoV-2 infection and severe cases. Patients with autoimmune inflammatory rheumatic diseases (AIIRDs) have been strongly recommended to be vaccinated according to the novel guidance because they are more vulnerable to SARS-CoV-2 infection. 1 However, patients with AIIRDs were largely excluded from vaccine trials, leading to very limited data on the safety of COVID-19 vaccines. Notably, previous studies mainly focused on mRNA and adenovirus vector vaccines; however, little is known about inactivated COVID-19 vaccines that also have been authorised by WHO and widely used in several most populated countries, for instance, China, Brazil, Turkey and Indonesia. 2 A large randomised clinical trial consisting of 40 382 participants has demonstrated two inactivated COVID-19 vaccines significantly reduced the risk of symptomatic COVID-19. 3 We conducted a real-world survey to evaluate the safety profiles and disease flare in patients with AIIRDs who received any dose of inactivated COVID-19 vaccines in China. From 1 Aug 2021 to 15 Oct 2021, eligible participants completed a predefined 25-question-based questionnaire by invitation on social media or visiting the outpatient department. There was no restriction on the time interval from vaccination to completing the survey.In total, 1507 adults patients with AIIRDs who received inactivated COVID-19 vaccine participated in this study (flow diagram in online supplemental figure 1). The median age of participants was 39 (IQR 31-51) years. There were 1166 (77.4%) female patients and 209 (13.9%) patients with self-identified allergic history. Systemic lupus erythematosus (SLE) (614, 40.7%) was the most common AIIRD among participants, followed by rheumatoid arthritis (RA) (434, 28.8%), Behcet's disease (BD, 122, 8.1%), psoriatic arthritis/psoriasis (PsA/PsO) (76, 5.0%), primary Sjogren's syndrome (74, 4.9%) and ankylosing spondylitis (44, 2.9%) (online supplemental figure 2).Among all participants, 450/1507 (29.9%) participants experienced adverse events (AEs) after vaccination (table 1). Local AEs, such as pain, redness or swelling at injection site, were reported to occur in 287 (19.0%) participants. Meanwhile, 260 (17.3%) patients reported systemic AEs after vaccination. Fatigue or sleepless (123, 8.2%) was the most reported systemic AE, followed by headache (82, 5.4%) and skin rash (55, 3.6%). The median time from vaccination shot to onset of AEs was 2 days. Most AEs were mild to moderate and self-limiting. Overall, 28 Letter *This question was described as 'Have you ever been allergic to any food, drug or environmental substance etc before?'.†Means anaphylactic shock, myocarditis, idiopathic thrombocytopenic purpura and death. ‡Three participants were not fully clear about that the side effects occured.after first or second vaccination.

The aim of this study was to assess the benefit of ultrasonography (US) contributing to 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria in diagnosing rheumatoid arthritis (RA), when anti-citrullinated protein (CCP) antibody and radiographic erosions are absent. Ninety-four patients suffering from arthritis of at least one joint in hands, symptom duration of less than 2 years, normal radiographs at baseline, and negative anti-CCP had 22 joint US assessments and were followed prospectively for at least 12 months. Sensitivity and specificity for final RA diagnosis based on 1987 RA criteria were determined for ultrasound variables. Logistic regression models were then fitted to evaluate predictive ability over and above the 2010 ACR/EULAR classification criteria. Twenty-nine of them were classified as RA patients and 65 had alternative diagnoses. There were significantly more joints with synovial hypertrophy, synovitis, and bone erosion detected by US in RA patients. The gray-scale (GS) variables positively correlated with acute phase reactants. The area under curve (AUC) values of GS and power Doppler (PD) were comparable, higher than bone erosion. However, regression analysis demonstrated that only PD involvement of joints, especially wrists, provided independently predictive data, with improved AUC values from 0.738 to 0.872 combined with 2010 ACR/EULAR classification criteria. PD scanning of hand joints, especially wrists, may provide independently assistance to 2010 ACR/EULAR criteria in the early diagnosis of RA in those patients who are negative for anti-CCP antibody.

ObjectiveTo unravel the dynamical trajectory and features of glucocorticoids (GC) tapering and discontinuation in patients with rheumatoid arthritis (RA) commencing GC with concomitant conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).MethodsWe used data from longitudinal real-world Treat-to-TARget in RA cohort. Patients with RA who started GC and contaminant csDMARDs therapy were included. The changes in GC dose and disease activity were evaluated. GC discontinuation rate was analysed using Kaplan-Meier analysis. The relapse profile within 6 months after GC discontinuation was also analysed.ResultsA total of 207 patients with RA were included. During a median follow-up of 38.6 months, 124 patients discontinued GC. The median prednisolone dose of 10 (5–10) mg/day at initiation was reduced by 50% in the first 6 months and then more slowly, to zero by 48 months eventually. The cumulative probabilities of GC discontinuation were 9.7%, 26.6%, 48.0% and 58.6% at month 6, years 1, 2 and 3, with calculated median time to GC cessation of 27 months. In 110 DMARD-naïve patients, the corresponding cumulative probabilities of GC discontinuation were, respectively, 12.7%, 30.0%, 50.9% and 60.6%, with calculated median time to GC cessation of 24 months. Of the 124 patients who discontinued GC, adding other csDMARDs or concomitant csDMARDs increment was documented in 28.2% of them. Approximately half of 124 patients were in clinical remission at GC discontinuation. Within 6 months after GC withdrawal, 79.1% (91/115) of patients maintained relapse free.ConclusionsIn patients with RA commencing GC besides csDMARDs, GC is feasibly discontinued with favourable control of disease activity in real-life setting, mostly without short-term flare. But the withdrawal time is far from reaching the recommended time frame, indicating the gap between real-world practice and current guidelines.

Introduction:The clinical features of psoriatic arthritis (PsA) varied in different studies from different countries, nevertheless rarely reported from China. We aimed to show the portraits of Chinese PsA patients. Methods: Demographics as well as clinical and laboratory data at the first visit of a PsA cohort were collected. Joints and entheses were further assessed by imaging techniques. The correlation between psoriasis severity index (PASI) and disease activity in PsA (DAPSA) was analyzed. The metabolic comorbidities were also explored among patients with different disease activity. Results: Three hundred patients with definite PsA were enrolled in this study; 159 (53.0%) of them were male. Their median age was 39 (31, 51) years with disease duration of 3 (0.6, 7) years; 15.6% patients were HLA-B27-positive, and 37.8% patients reported a family history of psoriasis or PsA. Among 300 patients, psoriasis presented earlier than arthritis in most of them (214, 74.0%), while 48 (16.6%) patients presented with arthritis before psoriasis. Articular involvement was found in 293 (97.7%) patients.Polyarticular type was most common, with proximal interphalangeal as most frequently involved joints. Axial joint involvement was found in 45 (15.4%) patients. Dactylitis was observed in 94 (31.3%) patients, most often at the second, third, and fourth toes. Enthesitis was found in 18 (6.0%) patients by physical examination, however in 129/227 (56.8%) patients by ultrasound. The DAPSA score was correlated with PASI (r = 0.22, p = 0.021). A variety of comorbidities were more often observed in patients with moderate/high disease activity comparing with those in remission/low-disease activity, especially type 2 diabetes with statistically significant difference (19.1 vs. 4.1%, p = 0.023). However, further logistic regression analysis showed diabetes was not independently associated with moderate/ high disease activity. The most frequently prescribed medication was methotrexate (101, 66.4%). Biological agents were applied in 25 (16.4%) patients. Conclusions: Polyarticular involvement was most common in Chinese PsA patients. Ultrasound dramatically increased the identification of peripheral enthesitis. Active PsA patients were more likely to have comorbidities.

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