Identification of clinical phenotypes of peripheral involvement in patients with spondyloarthritis, including psoriatic arthritis: A cluster analysis in the worldwide ASAS-PerSpA study

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 MunteanFloris 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

Research output: Contribution to journalArticlepeer-review

Abstract

Objective 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. Methods 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. Results 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. Conclusion These results suggest the presence of two main phenotypes (predominantly axial and predominantly peripheral) based on the presence and location of the peripheral manifestations.

Original languageEnglish
Article number001728
JournalRMD Open
Volume7
Issue number3
DOIs
Publication statusPublished - 8 Nov 2021

Keywords

  • ankylosing
  • arthritis
  • psoriatic
  • spondylitis

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