Relationship between damage clustering and mortality in systemic lupus erythematosus in early and late stages of the disease: cluster analyses in a large cohort from the Spanish Society of Rheumatology Lupus Registry
Pego Reigosa, J.M.; Lois Iglesias, A.; Rúa Figueroa, I.; Galindo, M.; Calvo Alén, J.; de Uña-Álvarez, Jacobo; Balboa Barreiro, Vanesa; Ruan, J.I.; Olivé, A.; Rodríguez Gómez, M.; Nebro, A.F.; Andrés, M.; Erausquin, C.; Tomero, E.; Rubio, L.H.; Isacelaya, E.U.; Freire, M.; Montilla, C.; Sánchez Atrio, A.I.; Santos Soler, G.; Zea, A.; Díez, E.; Narváez, J.; Blanco Alonso, R.; Silva Fernández, L.; Ruiz Lucea, M.E.; Fernández Castro, M.; Hernández Beriain, J.A.; Gantes Mora, M.; Hernández Cruz, B.; Pérez Venegas, J.; Pecondón Español, A.; Fernández Cid, C.M.; Ibáñez Barcelo, M.; Bonilla, G.; Torrente-Segarra, V.; Castellví, I.; Alegre, J.J.; Calvet, J.; de la Fuente, J.L.M.; Raya, E.; Vázquez-Rodríguez, T.R.; Quevedo-Vila, V.; Muñoz-Fernández, S.; Otón, T.; Rahman, A.; López-Longo, F.J.
Objectives: To identify patterns (clusters) of damage manifestations within a large cohort of SLE patients and evaluate the potential association of these clusters with a higher risk of mortality.
Methods: This is a multicentre, descriptive, cross-sectional study of a cohort of 3656 SLE patients from the Spanish Society of Rheumatology Lupus Registry. Organ damage was ascertained using the Systemic Lupus International Collaborating Clinics Damage Index. Using cluster analysis, groups of patients with similar patterns of damage manifestations were identified. Then, overall clusters were compared as well as the subgroup of patients within every cluster with disease duration shorter than 5 years.
Results: Three damage clusters were identified. Cluster 1 (80.6% of patients) presented a lower amount of individuals with damage (23.2 vs 100% in clusters 2 and 3, P < 0.001). Cluster 2 (11.4% of patients) was characterized by musculoskeletal damage in all patients. Cluster 3 (8.0% of patients) was the only group with cardiovascular damage, and this was present in all patients. The overall mortality rate of patients in clusters 2 and 3 was higher than that in cluster 1 (P < 0.001 for both comparisons) and in patients with disease duration shorter than 5 years as well.
Conclusion: In a large cohort of SLE patients, cardiovascular and musculoskeletal damage manifestations were the two dominant forms of damage to sort patients into clinically meaningful clusters. Both in early and late stages of the disease, there was a significant association of these clusters with an increased risk of mortality. Physicians should pay special attention to the early prevention of damage in these two systems.