Exploring the unifying concept of Spondyloarthritis: a latent class analysis of the REGISPONSER registry

Xabier Michelena, Alexandre Sepriano, Sizheng steven Zhao, Clementina López-Medina, Eduardo Collantes-Estévez, Pilar Font-Ugalde, Xavier Juanola, Helena Marzo-Ortega

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Abstract

Objectives
The aim of our study is to identify the potential distinct phenotypes within a broad Spondyloarthritis (SpA) population.

Methods
We conducted a cross-sectional study using the REGISPONSER registry with data from 31 specialist centres in Spain including patients with SpA who fulfilled the European Spondyloarthropathy Study Group (ESSG) criteria. A latent class analysis (LCA) was performed to identify the latent classes underlying SpA according to a set of predefined clinical and radiographic features, independently of expert opinion.

Results
In a population of 2319 SpA patients, a 5 classes LCA model yielded the best fit. Classes named ‘axial with spine involvement’ and ‘axial with isolated SIJ involvement” show a primarily axial SpA phenotype defined by inflammatory back pain and high HLA-B27 prevalence. Patients in class ‘axial + peripheral’ show similar distribution of manifest variables to previous classes but also have a higher likelihood of peripheral involvement (peripheral arthritis/dactylitis) and enthesitis, therefore representing a mixed (axial and peripheral) subtype. Classes ‘Peripheral + psoriasis’ and ‘Axial + peripheral + psoriasis’ are indicative of peripheral SpA (and/or PsA) with high likelihood of psoriasis, peripheral involvement, dactylitis, nail disease, and low HLA-B27 prevalence, while class ‘Axial + peripheral + psoriasis’ also exhibits increased probability of axial involvement both clinically and radiologically.

Conclusion
The identification of 5 latent classes in the REGISPONSER registry with significant overlap between axial and peripheral phenotypes is concordant with a unifying concept of SpA. Psoriasis and related features (nail disease and dactylitis) influence the phenotype of both axial and peripheral manifestations.
Original languageEnglish
JournalRheumatology
Early online date17 Jan 2024
DOIs
Publication statusE-pub ahead of print - 17 Jan 2024

Keywords

  • Spondyloarthritis
  • Axial Spondyloarthritis
  • Peripheral spondyloarthritis
  • unsupervised methods

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