Identifying damage clusters in patients with systemic lupus erythematosus.

Abstract

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). The study was conducted on the Hanyang BAE lupus cohort. Patients with disease duration <5years 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. 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. Patients in prevalent renal and ocular damage cluster had the highest AMS scores, while the cluster with frequent neuropsychiatric damage had the highest mortality.