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

Michelena, X.; Sepriano, A.; Zhao, SS.; Lopez-Medina, C.; Collantes-Estevez, E.; Font-Ugalde, P.; Juanola, X.; Marzo-Ortega, H.

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

All Authors

Michelena, X.

Sepriano, A.

Zhao, SS.

Lopez-Medina, C.

Collantes-Estevez, E.

Font-Ugalde, P.

Juanola, X.

Marzo-Ortega, H.

LTHT Author

Michelena, Xabier
Marzo-Ortega, Helena

LTHT Department

Rheumatology
NIHR Leeds Biomedical Research Centre

Publication Date

2024

Item Type

Journal Article
Multicenter Study

Abstract

OBJECTIVES: The aim of our study was to identify the potential distinct phenotypes within a broad SpA population. METHODS: We conducted a cross-sectional study using the REGISPONSER registry, which has data from 31 specialist centres in Spain, including patients with SpA who have fulfilled the 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 five-classes LCA model yielded the best fit. Classes named 'Axial with spine involvement' and 'Axial with isolated SI joint involvement' showed a primarily axial SpA phenotype defined by inflammatory back pain and high HLA-B27 prevalence. Patients in class 'Axial + peripheral' showed a similar distribution of manifest variables to previous classes but also had 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' were 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 exhibited increased probability of axial involvement both clinically and radiologically. CONCLUSION: The identification of five 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) influenced the phenotype of both axial and peripheral manifestations.