A cross-sectional study on the clinical phenotypes of rheumatoid arthritis.
- Author:
Wen Xin CAI
1
;
Shi Cheng LI
2
;
Yi Ming LIU
1
;
Ru Yu LIANG
1
;
Jing LI
1
;
Jian Ping GUO
1
;
Fan Lei HU
1
;
Xiao Lin SUN
1
;
Chun LI
1
;
Xu LIU
1
;
Hua YE
1
;
Li Zong DENG
3
;
Ru LI
1
;
Zhan Guo LI
1
Author Information
1. Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China.
2. Department of Oncology, the Second Affiliated Hospital of Soochow University, Suzhou 215123, Jiangsu, China.
3. Institute of Systems Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Suzhou Institute of Systems Medicine, Suzhou 215123, Jiangsu, China.
- Publication Type:Journal Article
- Keywords:
Clinical phenotypes;
Clustering analysis;
Rheumatoid arthritis
- MeSH:
Female;
Male;
Humans;
Cross-Sectional Studies;
Sjogren's Syndrome;
Rheumatoid Factor;
Arthritis, Rheumatoid;
Blood Sedimentation;
Phenotype
- From:
Journal of Peking University(Health Sciences)
2022;54(6):1068-1073
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE:To explore the characteristics and clinical phenotypes of rheumatoid arthritis (RA) and provide the basis for further understanding, interventions and outcomes of this disease.
METHODS:RA patients attended at Peking University People's Hospital from 2018 to 2021 were enrolled in the study. Data collection included demographic data, the sites and numbers of joints involved, extra-articular manifestations (EAM), comorbidities and laboratory variables. Statistical and bioinformatical analysis was performed to establish clinical subtypes by clustering analysis based on the type of joint involved, EAM involvement and other autoimmune diseases overlapped. The characteristics of each subtype were analyzed.
RESULTS:A total of 411 patients with RA were enrolled. The mean age was (48.84±15.17) years, and 346 (84.2%) were females. The patients were classified into 4 subtypes: small joint subtype (74, 18.0%), total joint subtype (154, 37.5%), systemic subtype (100, 24.3%), and overlapping subtype (83, 20.2%). The small joint subtype had no medium or large joint involvement, and 35.1% had systemic involvement. The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels and platelet count (PLT) were lower than those in other subtypes, and the rates of positive rheumatoid factors (RF-IgA and RF-IgG) were significantly higher in the small joint subtype. The total joint subtype had both large and small joint involvement but no systemic involvement. The rate of morning stiffness and positive antinuclear antibodies (ANA) in this subtype were lower than those in other subtypes. In the systemic subtype, interstitial lung disease and secondary Sjögren syndrome were the most common systemic involvements, with prominent levels of disease activity score 28-joint count (DAS28-ESR and DAS28-CRP). The overlapping subtype was commonly combined with Hashimoto's thyroiditis or primary Sjögren syndrome. Female in the overlapping subtype was more common than in other subtypes. This subtype was characterized by hyperglobulinemia, hypocomplementemia and high rate of positive ANA, especially spotting type.
CONCLUSION:Based on the clinical features, RA patients could be classified into 4 subtypes: small joint subtype, total joint subtype, systemic subtype, and overlapping subtype. Each subtype had its own clinical characteristics. They help for further understanding and a more individualized treatment strategy of RA.
