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Identifying damage clusters in patients with systemic lupus erythematosus
Ga Young Ahn1,2, Jiyoung Lee3, Soyoung Won3
1Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
Insights
Systemic lupus erythematosus (SLE) patients were clustered by organ damage. Renal/ocular damage correlated with higher SLE disease activity, while neuropsychiatric damage predicted increased mortality.
Area of Science:
- Rheumatology
- Immunology
- Genetics
Background:
- Systemic lupus erythematosus (SLE) can cause irreversible organ damage.
- Emerging evidence suggests distinct SLE subphenotypes.
- Identifying these subphenotypes is crucial for understanding disease heterogeneity.
Purpose of the Study:
- To identify distinct clusters of organ damage in SLE patients.
- To compare clinical manifestations, disease activity, mortality, and genetic risk scores (GRS) across these clusters.
Main Methods:
- Analysis of the Hanyang BAE lupus cohort (n=1130).
- Exclusion of patients with disease duration <5 years.
- K-means cluster analysis based on the Systemic Lupus International Collaborating Clinics Damage Index.
Main Results:
- Three distinct damage clusters were identified.
- Cluster 2 (renal/ocular damage) showed the highest SLE Disease Activity Index (AMS) scores.
- Cluster 3 (neuropsychiatric/musculoskeletal damage) exhibited the highest mortality rate (14.4%).
Conclusions:
- SLE patients with predominant renal and ocular damage experience higher disease activity.
- Neuropsychiatric damage in SLE is associated with increased mortality risk.
- Genetic risk scores did not significantly differ between damage clusters.
Aim:
Systemic lupus erythematosus (SLE) causes irreversible damage to organ systems. Recently, evidence has been obtained for subphenotypes of SLE. This study aimed to identify damage clusters and compare the associated clinical manifestations, SLE disease activity, mortality, and genetic risk scores (GRS).
Methods:
The study was conducted on the Hanyang BAE lupus cohort. Patients with disease duration <5 years were excluded to minimize confounding effects of disease duration. They were grouped into 3 clusters based on the Systemic Lupus International Collaborating Clinics Damage Index using k-means cluster analysis.
Results:
Among the 1130 analyzed patients, musculoskeletal damage was most prevalent (20.2%), followed by ocular (11.4%), renal (10.5%), and neuropsychiatric damage (10.2%). Three significantly different damage clusters were identified. Patients in cluster 1 (n = 824) showed the least damage. Cluster 2 (n = 195) was characterized by frequent renal (55.4%) and ocular (58.0%) damage, and cluster 3 (n = 111) was dominated by neuropsychiatric (100%) and musculoskeletal damage (35.1%). Cluster 2 had the highest adjusted mean AMS (adjusted mean SLE Disease Activity Index score; mean ± SD: 5.4 ± 2.9), while cluster 3 had the highest mortality (14.4%). Weighted GRS did not differ significantly between the clusters.
Conclusion:
Patients in prevalent renal and ocular damage cluster had the highest AMS scores, while the cluster with frequent neuropsychiatric damage had the highest mortality.
