Phenotypes Determined by Cluster Analysis and Their Survival in the Prospective European Scleroderma Trials and Research Cohort of Patients With Systemic Sclerosis

• Published in: Arthritis & rheumatology (Hoboken, N.J.) Vol. 71; no. 9; pp. 1553 - 1570
• Main Authors: Allanore, Yannick, Riemekasten, Gabriela, Vettori, Serena, Matucci‐Cerinic, Marco, Launay, David, Walker, Ulrich, Lapadula, Giovanni, Sierakowsky, Stanislaw, Siegert, Elise, Nicoara, Ileana, Kahan, André, Carreira, Patricia E., Novak, Srdan, Varju, Cecilia, Chizzolini, Carlo, Widuchowska, Malgorzata, Rozman, Blaz, Mallia, Carmel, Wu, Chen, Hij, Darin, Dhamadi, Roza, Wollheim, Frank, Wuttge, Dirk M., Andréasson, Kristofer, Martinovic, Duska, Balbir‐Gurman, Alexandra, Braun‐Moscovici, Yolanda, Lo Monaco, Andrea, Caramaschi, Paola, Henes, Jörg, Santamaria, Vera Ortiz, Heitmann, Stefan, Krasowska, Dorota, Himsel, Andrea, Da Silva, José Antonio Pereira, Stamenkovic, Bojana, Tikly, Mohammed, Tarner, Ingo, Damgaard, Kirsten, Mendoza, Antonio Zea, Sifuentes Giraldo, WA, Midtvedt, Øyvind, Riccieri, Valeria, Ionescu, Ruxandra Maria, Opris, Daniela, Groseanu, Laura, Cornateanu, Roxana Sfrent, Ionitescu, Razvan, Gherghe, Ana Maria, Gorga, Marilena, Bojinca, Mihai, Distler, Jörg H. W., Beyer, Christian, Meroni, Pierluigi, Ingegnoli, Francesca, Mouthon, Luc, De Keyser, Filip, Smith, Vanessa, Corrado, Ada, Pozzi, Maria R., Eyerich, Kilian, Knott, Elisabeth, Wiland, Piotr, Szmyrka‐Kaczmarek, Magdalena, Morgiel, Ewa, Krummel‐Lorenz, Brigitte, Günther, Claudia, Souza Müller, Carolina, Azevedo, Valderílio F., Groppa, Liliana, Chiaburu, Lealea, Russu, Eugen, Zenone, Thierry, Stebbings, Simon, Highton, John, Stamp, Lisa, Solanki, Kamal, Doube, Alan, Loyo, Esthela, Li, Mengtao, Rosato, Edoardo, Amoroso, Antonio, Tanaseanu, Cristina‐Mihaela, Dumitrascu, Alina, Foti, Rosario, Chirieac, Rodica, Ancuta, Codrina, Villiger, Peter, Adler, Sabine, Rubio, Silvia Rodriguez, Exposito, Marta Valero, Chatelus, Emmanuel, Chifflot, Hélène, Butrimiene, Irena, Rugiene, Rita, Karpec, Diana, Montoya, Fabiana, Limonta, Massimiliano, Brucato, Antonio Luca, Spertini, François
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.09.2019; John Wiley and Sons Inc
• Subjects: Adult; Aged; Antibodies; Autoantibodies; Autoantibodies - blood; Clinical trials; Cluster Analysis; Clustering; Connective tissue diseases; Connective tissues; Data bases; Databases, Factual; Disease control; Europe - epidemiology; Female; Heterogeneity; Humans; Impact damage; Male; Medical prognosis; Medicin och hälsovetenskap; Middle Aged; Original; Phenotype; Phenotypes; Phenotypic variations; Prognosis; Prospective Studies; Prototypes; Scleroderma; Scleroderma, Diffuse - blood; Scleroderma, Diffuse - epidemiology; Scleroderma, Diffuse - pathology; Scleroderma, Limited - blood; Scleroderma, Limited - epidemiology; Scleroderma, Limited - pathology; Scleroderma, Systemic - blood; Scleroderma, Systemic - epidemiology; Scleroderma, Systemic - pathology; Severity of Illness Index; Skin; Stability analysis; Survival; Systemic Sclerosis; Europe
• ISSN: 2326-5191; 2326-5205; 2326-5205
• DOI: 10.1002/art.40906

Objective Systemic sclerosis (SSc) is a heterogeneous connective tissue disease that is typically subdivided into limited cutaneous SSc (lcSSc) and diffuse cutaneous SSc (dcSSc) depending on the extent of skin involvement. This subclassification may not capture the entire variability of clinical phenotypes. The European Scleroderma Trials and Research (EUSTAR) database includes data on a prospective cohort of SSc patients from 122 European referral centers. This study was undertaken to perform a cluster analysis of EUSTAR data to distinguish and characterize homogeneous phenotypes without any a priori assumptions, and to examine survival among the clusters obtained. Methods A total of 11,318 patients were registered in the EUSTAR database, and 6,927 were included in the study. Twenty‐four clinical and serologic variables were used for clustering. Results Clustering analyses provided a first delineation of 2 clusters showing moderate stability. In an exploratory attempt, we further characterized 6 homogeneous groups that differed with regard to their clinical features, autoantibody profile, and mortality. Some groups resembled usual dcSSc or lcSSc prototypes, but others exhibited unique features, such as a majority of lcSSc patients with a high rate of visceral damage and antitopoisomerase antibodies. Prognosis varied among groups and the presence of organ damage markedly impacted survival regardless of cutaneous involvement. Conclusion Our findings suggest that restricting subsets of SSc patients to only those based on cutaneous involvement may not capture the complete heterogeneity of the disease. Organ damage and antibody profile should be taken into consideration when individuating homogeneous groups of patients with a distinct prognosis.