Sensorineural Hearing Loss in Major Systemic Autoimmune Rheumatic Diseases: A Systematic Review and Meta-Analysis

Background: Sensorineural hearing loss (SNHL) has increasingly been recognized as an extra-articular manifestation of systemic autoimmune rheumatic disease (SARDs), but its burden and clinical characteristics remain inconsistent. This systematic review and meta-analysis evaluated the prevalence, risk, audiometric characteristics, diagnostic methods and prognostic factors of SNHL in patients with major SARDs. Methods: A systematic search of the PubMed, Scopus and Cochrane Library databases was conducted between 25 June and 3 July 2026 in accordance with PRISMA 2020 guidelines. Observational studies evaluating SNHL in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), primary Sjögren syndrome (pSS) and systemic sclerosis (SSc) were included. Meta-analyses using a random-effects model were performed to estimate pooled prevalence and odds ratios (OR). Subgroup analyses, meta-regression, sensitivity analysis, publication bias assessment and certainty of evidence evaluation were performed. Results: Twenty-two studies met the eligibility criteria and were included. The pooled prevalence of SNHL was 50% (95% CI: 13-87%, p < 0.001) in patients with RA, 61% (95% CI: 22-95%, p < 0.001) in SLE, 31% (95% CI: 5-67%, p < 0.001) in pSS and 28% (95% CI: 14-44%, p < 0.001) in SS. Patients with RA (OR 1.92; 95% CI: 1.29-2.87) and SLE (OR 21.68; 95% CI: 4.65-100.99) had significantly increased odds of SNHL compared to healthy controls. Hearing loss was predominantly mild, bilateral, and cochlear in origin, and affected high or extended high frequencies. Longer disease duration and greater disease activity were associated with worse hearing thresholds. In exploratory analyses of RA studies, sample size, study setting, and study design were significant study-level moderators of heterogeneity. Conclusions: SNHL is reported with appreciable prevalence across several major systemic autoimmune rheumatic diseases, although prevalence estimates are highly heterogeneous and should be interpreted cautiously. Comparative evidence supports increased odds of SNHL in RA, whereas the magnitude of the association in SLE remains uncertain because of the limited and imprecise evidence. Evidence establishing increased comparative risk in pSS and SSc remains insufficient. Audiological assessment may be particularly relevant in patients with longstanding or active disease.