Work

Novel clustering approach to understanding distinct phenotypes of patients with systemic sclerosis

Year: 2026

Type: article

Abstract: Objectives: Despite earlier clustering studies on systemic sclerosis (SSc), how clinical subgroups differ in disease burden, treatment and patient-physician dynamics remains unclear. This study applied a novel clustering method to identify clinical subgroups. Design: Data were analysed from 1906 adults with SSc and their treating rheumatologists across the USA, France, Germany, Italy, Spain, UK and Japan (March-September 2022). Setting: Data were collected by Adelphi Real World as part of an independent survey titled the SSc I Disease Specific Programme, comprising data from the USA, France, Germany, Italy, Spain, UK and Japan. Participants: Physicians completed case record forms; patients completed self-reported questionnaires. Latent class clustering was conducted using five physician-reported variables: affected body areas, symptoms, severity, flares in the past 12 months and remission status. Interventions: This was a non-interventional, observational, retrospective study. Main outcome measures: A cluster solution was selected based on model fit and clinical interpretability. We compared time to diagnosis, symptoms at diagnosis, postdiagnosis trajectories, physician management and patient treatment perspectives across clusters. Results: We identified four clusters representing a gradient of disease severity, with all clusters comprising >75% females. Clusters 1/2 comprised younger patients with fewer concomitant conditions; Clusters 3/4 showed greater internal organ involvement and disease severity. Raynaud's phenomenon (RP) was the most frequent first symptom (physician-reported: 73%-85%; patient-reported: 63%-79%), but those with first symptoms other than RP were diagnosed faster (mean 1.06 vs 1.62 years). Musculoskeletal involvement was most pronounced in Clusters 2/4. Postdiagnosis (3.7-7.2 years), the number of symptoms and affected body areas decreased in Cluster 1, increased in Cluster 4 and remained relatively stable in Clusters 2/3. Improvement in disease progression within the first 2 years postdiagnosis was more often reported in Clusters 1/2 vs 3/4 (33%-34% vs 8%-20%). Most patients across clusters reported that the main benefit they wanted from treatment was to get rid of the disease. Conclusions: This analysis improves understanding of SSc beyond limited/diffuse subtypes. Musculoskeletal involvement emerged as a contributor to SSc burden, supporting its integration into monitoring/stratification strategies for earlier identification of high-risk patients.

Source: Journal of Scleroderma and Related Disorders

DOI: 10.1136/jsrd-2026-000041