{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T03:42:28Z","timestamp":1792554148682,"version":"4.5.0"},"reference-count":30,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Vestibular symptoms and objective vestibular dysfunction have been reported in patients with autoimmune and rheumatologic diseases, but available evidence remains fragmented and methodologically heterogeneous. Previous studies have often addressed audiovestibular involvement as a combined entity, limiting disease-specific interpretation of vestibular outcomes. Methods: A PRISMA 2020-based systematic review was conducted using predefined eligibility criteria targeting vestibular outcomes in autoimmune and systemic rheumatologic diseases. Observational studies reporting vestibular symptoms and\/or objective vestibular test results were included. Vestibular data were extracted even when studies reported combined audiovestibular outcomes. Certainty of evidence was assessed using the GRADE approach. Results: Twenty-seven studies were included in the qualitative synthesis, comprising 14 primary observational studies and 13 reviews. Vestibular involvement was reported across multiple diseases, including systemic sclerosis, giant cell arteritis, ankylosing spondylitis, psoriatic arthritis, Beh\u00e7et disease, primary Sj\u00f6gren syndrome, rheumatoid arthritis, systemic lupus erythematosus, antiphospholipid syndrome, and vasculitic disorders. Objective vestibular abnormalities were most frequently identified using caloric testing, balance integration measures, videonystagmography, and video head impulse testing. Systemic sclerosis and giant cell arteritis showed more consistently reported vestibular findings, although heterogeneity in assessment methods precluded quantitative synthesis. Conclusions: Vestibular involvement occurs across autoimmune and systemic inflammatory diseases, but overall certainty of evidence remains limited. Standardized vestibular assessment and longitudinal studies are needed to better define disease-specific vestibular phenotypes.<\/jats:p>","DOI":"10.3390\/jcm15082841","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T09:46:23Z","timestamp":1775727983000},"page":"2841","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Vestibular Involvement in Systemic Autoimmune and Rheumatologic Diseases: A Systematic Review and GRADE-Based Assessment"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9749-8607","authenticated-orcid":false,"given":"Juan C.","family":"Amor-Dorado","sequence":"first","affiliation":[{"name":"Otorhinolaryngology Division, Hospital Can Misses, 07800 Ibiza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7924-7406","authenticated-orcid":false,"given":"Miguel A.","family":"Gonz\u00e1lez-Gay","sequence":"additional","affiliation":[{"name":"Rheumatology Division, IIS\u2013Fundaci\u00f3n Jim\u00e9nez D\u00edaz, 28015 Madrid, Spain"},{"name":"Department of Medicine, School of Medicine, University of Cantabria, 39011 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"5798103","DOI":"10.1155\/2018\/5798103","article-title":"Audiovestibular symptoms in systemic autoimmune diseases","volume":"2018","author":"Ralli","year":"2018","journal-title":"J. Immunol. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"5072582","DOI":"10.1155\/2018\/5072582","article-title":"Update on vertigo in autoimmune disorders: From diagnosis to treatment","volume":"2018","author":"Girasoli","year":"2018","journal-title":"J. Immunol. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1007\/s00405-024-09001-4","article-title":"Audiovestibular symptoms in systemic sclerosis: A systematic review and meta-analysis","volume":"282","author":"Salvador","year":"2025","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1097\/MD.0b013e318173aa56","article-title":"Audiovestibular manifestations in patients with limited systemic sclerosis and centromere protein-B antibodies","volume":"87","author":"Llorca","year":"2008","journal-title":"Medicine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1097\/MAO.0b013e31818a086e","article-title":"Benign paroxysmal positional vertigo and clinical test of sensory interaction and balance in systemic sclerosis","volume":"29","author":"Llorca","year":"2008","journal-title":"Otol. Neurotol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1080\/00016480600606723","article-title":"Immune-mediated inner ear disease","volume":"126","author":"Bovo","year":"2006","journal-title":"Acta Otolaryngol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"73","DOI":"10.37349\/ei.2024.00129","article-title":"Decoding the impact of autoinflammatory\/autoimmune diseases on inner ear harmony and hearing loss","volume":"4","author":"Athanasopoulos","year":"2024","journal-title":"Explor. Immunol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1002\/lio2.508","article-title":"Autoimmune inner ear disease: A systematic review of management","volume":"5","author":"Breslin","year":"2020","journal-title":"Laryngoscope Investig. Otolaryngol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.1097\/00005537-200408000-00020","article-title":"Giant cell arteritis: A new association with benign paroxysmal positional vertigo","volume":"114","author":"Llorca","year":"2004","journal-title":"Laryngoscope"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1097\/MD.0b013e3182079866","article-title":"Audiovestibular manifestations in patients with ankylosing spondylitis","volume":"90","author":"Llorca","year":"2011","journal-title":"Medicine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2018","DOI":"10.3899\/jrheum.140559","article-title":"Investigations into audiovestibular manifestations in patients with psoriatic arthritis","volume":"41","author":"Pina","year":"2014","journal-title":"J. Rheumatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1007\/s00405-019-05403-x","article-title":"Audiological and vestibular measurements in Beh\u00e7et\u2019s disease","volume":"276","author":"Ertugrul","year":"2019","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.1017\/S0022215122000391","article-title":"Effects of primary Sj\u00f6gren\u2019s syndrome on hearing and vestibular systems","volume":"136","author":"Ulusoy","year":"2022","journal-title":"J. Laryngol. Otol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1007\/s00405-013-2551-8","article-title":"Does rheumatoid arthritis have an effect on audiovestibular tests?","volume":"271","author":"Kapusuz","year":"2014","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.otohns.2006.06.1255","article-title":"Audiovestibular disturbance in patients with systemic lupus erythematosus","volume":"136","author":"Onat","year":"2007","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Chen, J.-J., Hsu, C.-W., Chen, Y.-W., Chen, T.-Y., Zeng, B.-Y., and Tseng, P.-T. (2024). Audiovestibular Dysfunction Related to Anti-Phospholipid Syndrome: A Systematic Review. Diagnostics, 14.","DOI":"10.3390\/diagnostics14222522"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1097\/MAO.0000000000001223","article-title":"Vestibular involvement in patients with otitis media with ANCA-associated vasculitis","volume":"38","author":"Morita","year":"2017","journal-title":"Otol. Neurotol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1016\/j.rdc.2007.07.015","article-title":"Cogan\u2019s syndrome: An audiovestibular, ocular, and systemic autoimmune disease","volume":"33","author":"Mazlumzadeh","year":"2007","journal-title":"Rheum. Dis. Clin. N. Am."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"109488","DOI":"10.1016\/j.intimp.2022.109488","article-title":"Spatial architecture of the cochlear immune microenvironment in noise-induced and age-related sensorineural hearing loss","volume":"114","author":"Li","year":"2023","journal-title":"Int. Immunopharmacol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Miwa, T., and Okano, T. (2022). Role of Inner Ear Macrophages and Autoimmune\/Autoinflammatory Mechanisms in the Pathophysiology of Inner Ear Disease. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.861992"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Gomaa, N.A., Jimoh, Z., Campbell, S., Zenke, J.K., and Szczepek, A.J. (2021). Biomarkers for inner ear disorders: Scoping review on the role of biomarkers in hearing and balance disorders. Diagnostics, 11.","DOI":"10.3390\/diagnostics11010042"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"179","DOI":"10.7150\/ijms.97831","article-title":"Investigating the process of autoimmune inner ear disease: Unveiling the intricacies of pathogenesis and therapeutic strategies","volume":"22","author":"Wang","year":"2025","journal-title":"Int. J. Med. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: An emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/00005792-200301000-00002","article-title":"Audiovestibular manifestations in giant cell arteritis","volume":"82","author":"Llorca","year":"2003","journal-title":"Medicine"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1097\/MAO.0b013e3182016534","article-title":"Benign paroxysmal positional vertigo and clinical test of sensory interaction and balance in ankylosing spondylitis","volume":"32","author":"Llorca","year":"2011","journal-title":"Otol. Neurotol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1097\/MAO.0000000000001296","article-title":"Oculographic, Clinical Test of Sensory Integration and Balance and Computerized Dynamic Posturography Findings in Patients With Psoriatic Arthritis","volume":"38","author":"Llorca","year":"2017","journal-title":"Otol. Neurotol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"G\u00e1zquez, I., Soto-Varela, A., Aran, I., Santos, S., Batuecas, A., Trinidad, G., Perez-Garrigues, H., Gonzalez-Oller, C., Acosta, L., and Lopez-Escamez, J.A. (2011). High prevalence of systemic autoimmune diseases in patients with M\u00e9ni\u00e8re\u2019s disease. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0026759"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1016\/j.otorri.2009.01.012","article-title":"Audiovestibular manifestations in systemic vasculitis","volume":"60","year":"2009","journal-title":"Acta Otorrinolaringol. Esp."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1097\/01.mlg.0000184580.52723.9f","article-title":"Audiovestibular manifestations of sarcoidosis: A review of the literature","volume":"116","author":"Colvin","year":"2006","journal-title":"Laryngoscope"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/8\/2841\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T09:59:18Z","timestamp":1775728758000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/8\/2841"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,9]]},"references-count":30,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15082841"],"URL":"https:\/\/doi.org\/10.3390\/jcm15082841","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,9]]}}}