Identification of clinical phenotypes of peripheral involvement in patients with spondyloarthritis, including psoriatic arthritis: a cluster analysis in the worldwide ASAS-PerSpA study
Journal
RMD Open
ISSN
2056-5933
Date Issued
2021
Author(s)
Clementina López-Medina
Sylvie Chevret
Anna Molto
Joachim Sieper
Tuncay Duruöz
Uta Kiltz
Bassel Elzorkany
Najia Hajjaj-Hassouni
Ruben Burgos-Vargas
José Maldonado-Cocco
Nelly Ziade
Meghna Gavali
Victoria Navarro-Compan
Shue-Fen Luo
Alessandro Biglia
Kim Tae-Jong
Mitsumasa Kishimoto
Fernando M Pimentel-Santos
Jieruo Gu
Laura Muntean
Floris A van Gaalen
Pál Geher
Marina Magrey
Sebastián E Ibáñez-Vodnizza
Wilson Bautista-Molano
Walter Maksymowych
Pedro M Machado
Robert Landewé
Desirée van der Heijde
Maxime Dougados
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:sec><jats:title>Objective</jats:title><jats:p>To identify clusters of peripheral involvement according to the specific location of peripheral manifestations (ie, arthritis, enthesitis and dactylitis) in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), and to evaluate whether these clusters correspond with the clinical diagnosis of a rheumatologist.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Cross-sectional study with 24 participating countries. Consecutive patients diagnosed by their rheumatologist as PsA, axial SpA or peripheral SpA were enrolled. Four different cluster analyses were conducted: one using information on the specific location from all the peripheral manifestations, and a cluster analysis for each peripheral manifestation, separately. Multiple correspondence analyses and k-means clustering methods were used. Distribution of peripheral manifestations and clinical characteristics were compared across the different clusters.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The different cluster analyses performed in the 4465 patients clearly distinguished a predominantly axial phenotype (cluster 1) and a predominantly peripheral phenotype (cluster 2). In the predominantly axial phenotype, hip involvement and lower limb large joint arthritis, heel enthesitis and lack of dactylitis were more prevalent. In the predominantly peripheral phenotype, different subgroups were distinguished based on the type and location of peripheral involvement: a predominantly involvement of upper versus lower limbs joints, a predominantly axial enthesitis versus peripheral enthesitis, and predominantly finger versus toe involvement in dactylitis. A poor agreement between the clusters and the rheumatologist‘s diagnosis as well as with the classification criteria was found.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>These results suggest the presence of two main phenotypes (predominantly axial and predominantly peripheral) based on the presence and location of the peripheral manifestations.</jats:p></jats:sec>
Subjects
spondylitis
;
ankylosing
;
arthritis
;
psoriatic
;
arthritis
;
arthritis, psoriatic
;
cluster analysis
;
cross-sectional studies
;
humans
;
phenotype
;
spondylarthritis
;
biological product
;
c reactive protein
;
disease modifying antirheumatic drug
;
hla b27 antigen
;
achilles tendon
;
adult
;
ankylosing spondylitis disease activity score
;
article
;
asas health index
;
axial spondyloarthritis
;
bath ankylosing spondylitis disease activity index
;
bath ankylosing spondylitis functional index
;
cluster analysis
;
comparative study
;
controlled study
;
cross-sectional study
;
dactylitis
;
disease activity
;
disease burden
;
disease duration
;
enthesitis
;
female
;
fibromyalgia
;
human
;
interphalangeal joint
;
k means clustering
;
lower limb
;
major clinical study
;
male
;
observational study
;
phenotype
;
physical performance
;
prevalence
;
proximal interphalangeal joint
;
psoriatic arthritis
;
rheumatologist
;
psoriatic arthritis
;
spondylarthritis