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Exploring clinical subtypes of Chinese patients with psoriatic arthritis based on cluster analysis: a national
Yaqi Zhao1,2,3,4, Hongbin Li5, Xinwang Duan6
1Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Objective:
This study aimed to identify distinct clinical phenotypes within a Chinese cohort of patients with psoriatic arthritis (PsA).
Methods:
A total of 1074 patient data were analyzed from the Chinese Psoriatic Arthritis Registry (CREPAR). A two-step clustering approach was used to identify patient subtypes based on the unsupervised clustering of baseline clinical characteristics. Kaplan-Meier curves were used to compare long-term remission probabilities across subtypes, and Cox proportional hazards regression models were used to identify independent risk factors.
Results:
The cluster analysis identified three subtypes of patients with distinct clinical presentations, laboratory tests, and prognoses. Cluster 1 patients presented with the most extensive and intense polyarticular inflammation, accompanied by a 'concentrated-severe' pattern of dactylitis across multiple sites. Patients in Cluster 2 had the least peripheral joint involvement, with an extremely low incidence of dactylitis (0.8%). Cluster 3 is characterised by dactylitis in almost all patients (98.9%), presenting a extensive pattern with moderate frequency across sites, alongside common peripheral arthritis. A survival analysis revealed highly significant differences between subtypes in the probability curves for non-remission. Across all subtypes, the Cox regression identified the following independent risk factors: a later age at onset of arthritis, a longer duration of psoriasis, and high baseline DAPSA scores.
Conclusion:
The purpose of this study is to establish a clinical risk framework for Chinese PsA patients. Identification of high-risk patients based on specific joint/dactylitis patterns is crucial to guiding intensive treatment.
