{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:34:05Z","timestamp":1787164445389,"version":"build-2736575974"},"reference-count":48,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T00:00:00Z","timestamp":1744156800000},"content-version":"unspecified","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2025,3,21]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Systemic lupus erythematosus (SLE), a systemic autoimmune disease with heterogeneous severity, poses a challenge in classifying patients due to its dynamic phenotype. We therefore aimed to identify clinical clusters at diagnosis and at the last available visit to define subgroups with different disease trajectories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study included 278 SLE patients fulfilling the 2019 EULAR\/American College of Rheumatology classification criteria. Data were extracted from the patient\u2019s medical record, encompassing demographic, clinical and immunological features. Two hierarchical clustering analyses were performed: one at diagnosis and the other at the last available visit based on 23 clinical manifestations. We assessed the distribution of autoantibodies among clusters, and survival analyses compared prognosis using the Cox regression model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three symptom clusters were identified at diagnosis and confirmed at the last available visit, with consistent clinical profiles. The largest, clusters 1\/1\u2032, exhibited early articular (95.3%; p=0.0043) and mucocutaneous (58.7%; p=0.0031) symptoms with the best survival rate. Clusters 2\/2\u2032 displayed the most severe phenotype, including renal involvement (62.2%; p&lt;0.0001), positivity for anti-DNA (90.0%; p=0.0151) and anti-Sm (34.4%; p&lt;0.0001) autoantibodies, and worse prognosis. Clusters 3\/3\u2032 exhibited a high proportion of SLE patients fulfilling the definition of mixed connective tissue disease (MCTD) (50.0%; p&lt;0.0001) with anti-U1-RNP 70\u2009kDa autoantibodies (87.5%; p&lt;0.0001). Clusters 1 and 2 remained stable during follow-up, cluster 2 even expanding over time, while over half of cluster 3 patients transitioned to a different subgroup.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We identified a distinct MCTD phenotype within SLE patients, a severe SLE phenotype with poor prognosis, and a third group of SLE patients with lower visceral involvement. Clusters remained stable over time, providing insights into disease progression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2024-005330","type":"journal-article","created":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T01:45:16Z","timestamp":1744249516000},"page":"e005330","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Prognostic insights from symptom clustering analysis in systemic lupus erythematosus"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-5768-3159","authenticated-orcid":false,"given":"Erwan","family":"Le Tallec","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Clinical Immunology, CHU de Rennes, Rennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corentin","family":"Bourg","sequence":"additional","affiliation":[{"name":"Department of Cardiology, CHU de Rennes, Rennes, Bretagne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillaume","family":"Bouzill\u00e9","sequence":"additional","affiliation":[{"name":"INSERM, LTSI UMR 1099, CHU de Rennes, Rennes, Bretagne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9438-3350","authenticated-orcid":false,"given":"Nicolas","family":"Belhomme","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Immunology, CHU de Rennes, Rennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estelle","family":"Le Pabic","sequence":"additional","affiliation":[{"name":"INSERM, CIC UMR 1414, CHU de Rennes, Rennes, Bretagne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phanie","family":"Guillot","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Function Testing, CHU de Rennes, Rennes, Bretagne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Droitcourt","sequence":"additional","affiliation":[{"name":"Department of Dermatology, CHU de Rennes, Rennes, Bretagne, France"},{"name":"INSERM, IRSET UMR 1085, Rennes 1 University, Rennes, Bretagne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoinette","family":"Perlat","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Immunology, CHU de Rennes, Rennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phane","family":"Jouneau","sequence":"additional","affiliation":[{"name":"INSERM, IRSET UMR 1085, Rennes 1 University, Rennes, Bretagne, France"},{"name":"Department of Respiratory Medicine, CHU de Rennes, Rennes, Bretagne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3083-2441","authenticated-orcid":false,"given":"Vincent","family":"Sobanski","sequence":"additional","affiliation":[{"name":"INFINITE\u2014Institute for Translational Research in Inflammation, Lille, France"},{"name":"Institut Universitaire de France (IUF), Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erwan","family":"Donal","sequence":"additional","affiliation":[{"name":"Department of Cardiology, CHU de Rennes, Rennes, Bretagne, France"},{"name":"INSERM, LTSI UMR 1099, CHU de Rennes, Rennes, Bretagne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain","family":"Lescoat","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Immunology, CHU de Rennes, Rennes, France"},{"name":"INSERM, IRSET UMR 1085, Rennes 1 University, Rennes, Bretagne, 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