Lupus & antiphospholipid syndrome
Prognostic insights from symptom clustering analysis in systemic lupus erythematosus
Authors' conclusion
We identified a distinct MCTD phenotype within SLE patients, a severe SLE phenotype with poor prognosis, and a third group of SLE patients with lower visceral involvement. Clusters remained stable over time, providing insights into disease progression.
Study context
- Population
- Systemic lupus erythematosus (SLE) patients fulfilling the 2019 EULAR/ACR classification criteria
- Participants
- 278 patients
- Exposure
- Symptom clusters at diagnosis and at last available visit
- Outcome
- Clinical clusters at diagnosis and at last available visit, based on 23 clinical manifestations
- Follow-up
- Diagnosis and last available visit
Methodological detailshierarchical clustering analysis, Cox regression
- Hierarchical clustering analysis
- Cox regression
Main finding
As reported in the abstract
Clinical features by symptom cluster
| Group | Early articular symptoms | Early mucocutaneous symptoms | Renal involvement | Anti-DNA positivity | Anti-Sm positivity | Fulfilling mixed connective tissue disease (MCTD) definition | Anti-U1-RNP 70 kDa positivity |
|---|---|---|---|---|---|---|---|
| Clusters 1/1' | 95.3% | 58.7% | |||||
| Clusters 2/2' | 62.2% | 90.0% | 34.4% | ||||
| Clusters 3/3' | 50.0% | 87.5% |
Early articular symptoms
Clusters 1/1'95.3%
Clusters 2/2'— not stated in the abstract
Clusters 3/3'— not stated in the abstract
Early mucocutaneous symptoms
Clusters 1/1'58.7%
Clusters 2/2'— not stated in the abstract
Clusters 3/3'— not stated in the abstract
Renal involvement
Clusters 1/1'— not stated in the abstract
Clusters 2/2'62.2%
Clusters 3/3'— not stated in the abstract
Anti-DNA positivity
Clusters 1/1'— not stated in the abstract
Clusters 2/2'90.0%
Clusters 3/3'— not stated in the abstract
Anti-Sm positivity
Clusters 1/1'— not stated in the abstract
Clusters 2/2'34.4%
Clusters 3/3'— not stated in the abstract
Fulfilling mixed connective tissue disease (MCTD) definition
Clusters 1/1'— not stated in the abstract
Clusters 2/2'— not stated in the abstract
Clusters 3/3'50.0%
Anti-U1-RNP 70 kDa positivity
Clusters 1/1'— not stated in the abstract
Clusters 2/2'— not stated in the abstract
Clusters 3/3'87.5%
- Articular symptoms, clusters 1/1'
- P = 0.0043
- Mucocutaneous symptoms, clusters 1/1'
- P = 0.0031
- Renal involvement, clusters 2/2'
- P < 0.0001
- Anti-DNA, clusters 2/2'
- P = 0.0151
- Anti-Sm, clusters 2/2'
- P < 0.0001
- MCTD, clusters 3/3'
- P < 0.0001
- Anti-U1-RNP 70 kDa, clusters 3/3'
- P < 0.0001
Observational data: associations, not effects.
Further findings
Survival / prognosis by cluster
- Clusters 1/1' had the best survival rate; clusters 2/2' worse prognosis
Cluster stability over follow-up
- Clusters 1 and 2 remained stable, cluster 2 even expanding over time; over half of cluster 3 patients transitioned to a different subgroup
Original publication
Prognostic insights from symptom clustering analysis in systemic lupus erythematosus. RMD Open. Published 9 April 2025. doi:10.
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