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Evaluating clinical heterogeneity in relapsing polychondritis through unsupervised cluster analysis
Wenping Pan1, Liguo Yin2, Lantao Wang3
1Department of Rheumatology and Immunology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China.
Arthritis Research & Therapy
|July 11, 2026
Summary
Relapsing polychondritis (RP) is a heterogeneous autoimmune disease. Cluster analysis identified three distinct RP phenotypes, aiding in prognosis prediction and treatment strategies for better patient outcomes.
Area of Science:
- Rheumatology
- Immunology
- Clinical Medicine
Background:
- Relapsing polychondritis (RP) is a rare autoimmune condition with variable clinical presentations, treatment responses, and prognoses.
- Currently, no validated biomarkers exist for clinical application in managing RP.
- Understanding RP heterogeneity is crucial for improving patient outcomes.
Purpose of the Study:
- To apply cluster analysis to identify distinct clinical phenotypes of relapsing polychondritis.
- To determine prognosis predictors for each identified phenotype.
- To guide treatment decisions and enhance patient management strategies.
Main Methods:
- Utilized K-means clustering algorithm on data from 135 RP patients across two centers (2005-2024).
- Determined the optimal number of clusters (K=3) using Elbow Method and Silhouette Analysis.
- Employed random forest analysis to identify key distinguishing factors between subtypes.
Main Results:
- Identified three distinct RP phenotypes: Cluster 1 (hyperinflammatory, respiratory; 33.3%), Cluster 2 (severe, multi-organ; 8.1%), and Cluster 3 (favorable prognosis, male predominance; 58.52%).
- Clusters 1 and 2 exhibited the highest rates of clinical deterioration.
- Cluster 3 demonstrated the most favorable prognosis.
Conclusions:
- Relapsing polychondritis is a heterogeneous clinical syndrome, not a single entity.
- Systemic inflammation markers (CRP, CAR, ESR) and sensory organ involvement (hearing impairment, inner ear dysfunction) are critical for differentiating RP subtypes.
- Phenotypic classification can inform prognosis and treatment strategies for relapsing polychondritis.