Evidence map›Paper›PMID 41299138›Full record

ArticleClinical rheumatology2026

Association of Th17/Treg immune imbalance and cardiovascular complications in RA patients: retrospective cohort study in refractory subgroups.

Qin-Yi Su, Meng-Yuan Wang, Liu Yang, Chen-Qi Xue, Jing-Wen Cheng, Zi-Qian Liang, Xin-Yao Liu, Zhi-Yuan Ren, Yuan-Chi Li, Han Niu and 2 more

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In one paragraph

Article in Clinical rheumatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Qin-Yi Su *Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.ORCID http://orcid.org/0000-0001-8235-0482
Meng-Yuan Wang *Shanxi Provincial Key Laboratory of Rheumatism Immune Microecology, Taiyuan, Shanxi, China.ORCID http://orcid.org/0009-0000-1139-7435
Liu Yang *Department of Gynaecology and Obstetrics, Shanxi Bethune Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.ORCID http://orcid.org/0000-0002-7777-9994
Chen-Qi XueShanxi Provincial Key Laboratory of Rheumatism Immune Microecology, Taiyuan, Shanxi, China.ORCID http://orcid.org/0009-0003-2889-2020
Jing-Wen ChengShanxi Provincial Key Laboratory of Rheumatism Immune Microecology, Taiyuan, Shanxi, China.ORCID http://orcid.org/0009-0000-2871-0731
Zi-Qian LiangShanxi Provincial Key Laboratory of Rheumatism Immune Microecology, Taiyuan, Shanxi, China.ORCID http://orcid.org/0009-0009-7480-3379
Xin-Yao LiuShanxi Provincial Key Laboratory of Rheumatism Immune Microecology, Taiyuan, Shanxi, China.ORCID http://orcid.org/0009-0007-0478-8981
Zhi-Yuan RenShanxi Provincial Key Laboratory of Rheumatism Immune Microecology, Taiyuan, Shanxi, China.ORCID http://orcid.org/0009-0001-8088-2204
Yuan-Chi LiShanxi Provincial Key Laboratory of Rheumatism Immune Microecology, Taiyuan, Shanxi, China.ORCID http://orcid.org/0009-0001-6979-9055
Han NiuShanxi Provincial Key Laboratory of Rheumatism Immune Microecology, Taiyuan, Shanxi, China.ORCID http://orcid.org/0009-0009-7739-5163
Hui-Shan SunShanxi Provincial Key Laboratory of Rheumatism Immune Microecology, Taiyuan, Shanxi, China.ORCID http://orcid.org/0009-0006-8162-1942
Sheng-Xiao ZhangDepartment of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China. zhangshengxiao1@sxmu.edu.cn.ORCID http://orcid.org/0000-0003-1341-7588

Funding

Innovative Research Group Project of the National Natural Science Foundation of China No. 82001740Natural Science Foundation of Shanxi Province No. 202203021221269
6 · The paper itself

Abstract

backgroundPatients with rheumatoid arthritis (RA) face significantly elevated cardiovascular risks, yet the underlying immunological mechanisms remain incompletely understood, particularly in refractory RA subgroups.

objectiveTo investigate the association between Th17/Treg immune imbalance and cardiovascular complications in RA patients, with a focus on delineating the unique pathological mechanisms in refractory subgroups.

methodsThis single-center retrospective cohort study (2015-2024) included 3,464 RA patients (1,872 common RA; 1,592 refractory RA) diagnosed per 2010 ACR/EULAR criteria. Flow cytometry quantified Th17 and Treg absolute counts and ratios. Patients were stratified into four immunophenotypic subgroups: Group A (Treg-deficient/Th17-normal-or-low), Group B (Treg-normal-or-high/Th17-normal-or-low), Group C (Treg-normal-or-high/Th17-high), and Group D (Treg-deficient/Th17-high). Cardiovascular outcomes included coronary artery disease, myocardial infarction, and related events.

resultsIn all RA, elevated Th17/Treg ratios correlated with increased cardiovascular risk (χ

conclusionTh17/Treg imbalance serves as a central predictor of cardiovascular risk in general RA, whereas Treg deficiency dominates in refractory RA. The interplay between immune dysregulation (Treg exhaustion), pro-inflammatory HDL remodeling, and behavioral factors constructs an "immune-metabolic-environmental" axis driving cardiovascular pathogenesis. These findings provide novel biomarkers and precision intervention targets for stratified RA management. Key Points • Treg absolute count, not Th17/Treg ratio, independently predicts cardiovascular events in refractory RA. • A novel immunophenotypic stratification (Groups A-D) identifies high-risk Group A with the highest CAD incidence. • Treg deficiency drives pro-inflammatory HDL remodeling, revealing an immune-metabolic crosstalk in RA. • Distinct mechanisms exist between common and refractory RA, defining an integrated immune-metabolic-environmental axis.

Indexed as

Arthritis, RheumatoidCardiovascular DiseasesTh17 CellsT-Lymphocytes, RegulatoryAdultAgedFemaleHeart Disease Risk FactorsHumansMaleMiddle AgedRetrospective StudiesCardiovascular complicationsImmunometabolismRefractory RARheumatoid arthritisTh17/Treg ratio

Identifiers

PMID41299138

What Socratic holds

Textmetadata
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.