Photo Credit: Betka82
The following is a summary of “Identification of distinct subgroups of Sjögren’s disease by cluster analysis based on clinical and biological manifestations: data from the cross-sectional Paris-Saclay and the prospective ASSESS cohorts,” published in the April 2024 issue of Rheumatology by Nguyen et al.
Researchers conducted a retrospective study to identify different subgroups of Sjögren’s disease through cluster analysis of subjective symptoms and clinical and biological manifestations. They then compared the prognoses of patients within these subgroups.
They utilized two independent cohorts from France: the Paris-Saclay and Assessment of Systemic Signs and Evolution of Sjögren’s Syndrome (ASSESS) cohorts. Employing unsupervised multiple correspondence analysis, they identified clusters in the Paris-Saclay cohort and validated them using the ASSESS cohort. Subsequently, they compared disease activity using ESSDAI, symptom state using ESSPRI, and lymphoma incidence among clusters.
The results showed 534 patients from the Paris-Saclay cohort (502 [94%] women, 32 [6%] men, with a median age of 54 years [IQR 43-64]), recruited between 1999 and 2022, and 395 patients from the ASSESS cohort (370 [94%] women, 25 [6%] men, median age 53 years [43-63]), recruited between 2006 and 2009. Hierarchical cluster analysis revealed three distinct subgroups of patients: those with B-cell active disease and low symptom burden (BALS), those with high systemic disease activity (HSA), and those with low systemic disease activity and high symptom burden (LSAHS). Disease activity and symptom states worsened for patients in the BALS cluster (67 [36%] of 186 patients with ESSPRI score <5 at month 60 vs 92 [49%] at inclusion; P<0·0001), with lymphomas occurring in BALS (n=5, median of 70 months [IQR 42-104] after inclusion) and HSA clusters (n=6 from 158 patients, median of 23 months [13-83] after inclusion). All Paris-Saclay lymphoma patients were in BALS or HSA; this clustering classification did not correlate with previous symptom-based classification.
Investigators concluded that three subgroups of Sjögren’s disease patients suggest varying prognoses and potentially heterogeneous disease mechanisms or stages, informing future therapeutic trial stratification.
Source: thelancet.com/journals/lanrhe/article/PIIS2665-9913(23)00340-5/fulltext