scholarly journals OP0047 IDENTIFICATION OF CLINICAL PHENOTYPES IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS, PERIPHERAL SPONDYLOARTHRITIS AND PSORIATIC ARTHRITIS ACCORDING TO PERIPHERAL MUSCULOSKELETAL MANIFESTATIONS: A CLUSTER ANALYSIS IN THE INTERNATIONAL ASAS-PERSPA STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 24.2-25
Author(s):  
C. López-Medina ◽  
S. Chevret ◽  
A. Moltó ◽  
J. Sieper ◽  
M. T. Duruöz ◽  
...  
Keyword(s):  
Cluster Analysis ◽  
Prior Information ◽  
Hla B27 ◽  
Peripheral Arthritis ◽  
Specific Location ◽  
High Prevalence ◽  
Musculoskeletal Manifestations ◽  
Low Prevalence ◽  
Cluster 2 ◽  
Axial Involvement

Background:Patients with a diagnosis of Spondyloarthritis (SpA) and Psoriatic Arthritis (PsA) may have predominant axial or peripheral symptoms, and the frequency and distribution of these symptoms may determine the clinical diagnosis by the rheumatologist (“clinical clusters”). Clustering analysis represents an unsupervised exploratory analysis which tries to identify homogeneous groups of cases (“statistical clusters”) without prior information about the membership for any of the cases.Objectives:To identify “statistical clusters” of peripheral involvement according to the specific location of these symptoms in the whole spectrum of SpA and PsA (without prior information about the diagnosis of the patients), and to evaluate whether these “statistical clusters” are in agreement with the “clinical clusters”.Methods:Cross-sectional and multicentre study with 24 participating countries. Consecutive patients considered by their treating rheumatologist as suffering from either PsA, axial SpA (axSpA) or peripheral SpA (pSpA) were enrolled. Four different cluster analyses were conducted: the first one using information about the specific location from all the peripheral musculoskeletal manifestations (i.e., peripheral arthritis, enthesitis and dactylitis), and thereafter a cluster analysis for each peripheral manifestation individually. Multiple correspondence analyses and k-means clustering methods were used. Distribution of peripheral manifestations and clinical characteristics were compared across the different clusters.Results:4465 patients were included in the analysis. Two clusters were found with regard to the location of all the peripheral manifestations (Fig. 1). Cluster 1 showed a low prevalence of peripheral manifestations in comparison with cluster 2; however, when peripheral involvement appeared in cluster 1, this was mostly represented by arthritis of hip, knee and ankle, as well as enthesitis of the heel. Patients from cluster 1 showed a higher prevalence of males (63% vs 44%), HLA-B27 positivity (69% vs 38%) and axial involvement (80% vs 52%), as well as more frequent diagnosis of axSpA (66% vs 21%) and more frequently fulfilling the ASAS axSpA criteria (69% vs. 41%). Patients from cluster 2 showed a higher prevalence of psoriasis (63% vs 25%), a more frequent diagnosis of PsA (61% vs 19%), and they fulfilled more frequently the peripheral ASAS (26% vs 11%) and the CASPAR criteria (57% vs 19%).Figure 1.Distribution of the peripheral involvement across clustersThree clusters were found with regard to the location of the peripheral arthritis. Clusters 2 and 3 showed a high prevalence of peripheral joint disease, although this was located more predominantly in the lower limbs in cluster 2, and in the upper limbs in cluster 3. Cluster 1 showed a higher prevalence of males, HLA-B27 positivity, axial involvement, a lower presence of psoriasis, a more frequent diagnosis of axSpA and fulfilling the ASAS axSpA criteria in comparison with clusters 2 and 3, respectively. Clusters 2 and 3 showed a higher prevalence of enthesitis and dactylitis in comparison with cluster 1, a more frequent diagnosis of PsA and fulfillment of the CASPAR criteria.Information about the location of enthesitis exhibited three groups: cluster 1 showed a very low prevalence of enthesitis, while cluster 2 and 3 showed a high prevalence of enthesitis, with a predominant involvement of axial enthesis in cluster 2 and peripheral enthesitis in cluster 3.Finally, the analysis of dactylitis also exhibited three clusters that showed a very low prevalence of dactylitis, predominantly toes and predominantly fingers involvement, respectively.Conclusion:These results suggest the presence of heterogeneous patterns of peripheral involvement in SpA and PsA patients without clearly defined groups, confirming the clear overlap of these peripheral manifestations across the different underlying diagnoses.Acknowledgements:This study was conducted under the umbrella of ASAS with unrestricted grant of Abbvie, Pfizer, Lilly, Novartis, UCB, Janssen and Merck.Disclosure of Interests:None declared

Axial Involvement in Psoriatic Arthritis: Effect on Peripheral Arthritis and Differential Features With Axial Spondyloarthritis in South America

2021 ◽  
pp. jrheum.201627
Author(s):  
Rodrigo García Salinas ◽  
Einer Sanchez Prado ◽  
Santiago Ruta
Keyword(s):  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
South America ◽  
Axial Spondyloarthritis ◽  
Hla B27 ◽  
Skin Involvement ◽  
Peripheral Arthritis ◽  
Male Sex ◽  
Reported Data ◽  
Axial Involvement

Reported data of axial involvement in psoriatic arthritis (PsA) are variable (25–70%). This variability is mainly linked to different ways of defining this feature. Gladman1 established that the prevalence of axial involvement in PsA was close to 50% and that it is associated with HLA-B27. Likewise, psoriasis (PsO) spondylitis, unlike ankylosing spondylitis (AS), is characterized by not having a greater preponderance of the male sex, greater skin involvement, and a less severe course.2

scholarly journals FRI0341 RISK FACTORS FOR AXIAL INVOLVEMENT IN EARLY PSORIATIC ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 764-765
Author(s):  
E. Gubar ◽  
E. Loginova ◽  
S. Glukhova ◽  
T. Korotaeva
Keyword(s):  
Psoriatic Arthritis ◽  
Skin Lesion ◽  
Early Stage ◽  
Hla B27 ◽  
Peripheral Arthritis ◽  
X Ray ◽  
Male Sex ◽  
Early Psoriatic Arthritis ◽  
Axial Involvement ◽  
Lesion Severity

Background:Axial Involvement in psoriatic arthritis (PsA) is quite common [1]. Predictors of axial involvement at early-stage of disease haven’t been sufficiently studied.Objectives:To identify predictors of axial involvement in PsA patients (pts) at early-stage of disease.Methods:95 patients (pts) (M/F–47/48) with early PsA fulfilling the CASPAR criteria were included. All pts had peripheral arthritis for≤2 years; no inflammatory back pain (IBP) pts were specifically selected. Mean (Me) age 36.5±10.7 yrs, disease duration 12.2±10.3 mo. Pts underwent standard clinical examination of PsA activity. Me disease activity indexes DAS=4.0±1.4, DAS28=4.2±1.1, BASDAI=4.5±1.6; Me pts global disease activity VAS 56.9±17.1. All patients were evaluated for the presence of IBP by ASAS criteria, underwent sacroiliac joints (SIJs) X-ray (pelvic radiographs) and HLA B27 antigen status study. MRI of SIJs was performed in 79 pts, regardless of IBP presence, on Signa Ovation 0.35T. Radiographic sacroiliitis (R-SI) was identified according to New York criteria (unilateral grade≥3 or bilateral grade≥2). Bone marrow edema/ osteitis on MRI (STIR) was considered active MRI sacroiliitis (MRI-SI). X-ray and MRI results were evaluated by an independent reader. IBP was observed in 63 (66.3%) cases, MRI-SI in 28 of 79 (35.4%) examined cases, R-SI in 29 (30.5%) cases. Skin lesion severity was evaluated as body surface area (BSA) affected: minor at <3%, mild at 3-10%, severe at >10%. Pts were split into 2 groups (gr.): those with axial involvement (axPsA), that is with IBP and/or R-SI and/or MRI-SI; and those without axial involvement (having only peripheral PsA [pPsA]).The axPsA gr. included 65 (68.4%) cases, the pPsA gr. 30 (31.6%) cases. Multi-dimensional step-by-step discriminant analysis was used to identify a group of features that are more typical for the axPsA patients.Results:The following features proved to be the most informative: male sex (р = 0.300), presence of HLA B27 (р = 0.107), mild or high DAS (р = 0.098), skin lesion severity BSA>3% (р = 0.118), and CRP > 5 mg/L (0.038).Sensitivity of model 79.0%, specificity of model 57.7%. Area under ROC curve 0.756; 95% CI (0.642-0.869).Conclusion:It is a combination of features – male sex, HLA-B27 positivity, mild or high activity of peripheral arthritis according to DAS, CRP > 5 mg/L, and BSA> 3% – that constitutes a clinical predictor for the development of axial involvement in early psoriatic arthritis.References:[1]V. Chandran et al. Curr Opin Rheumatol. 2019;31:329-34Disclosure of Interests:ELENA GUBAR: None declared, Elena Loginova Speakers bureau: Janssen, Svetlana Glukhova: None declared, Tatiana Korotaeva Grant/research support from: Pfizer, Consultant of: Abbvie, BIOCAD, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Novartis-Sandoz, Pfizer, UCB, Speakers bureau: Abbvie, BIOCAD, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Novartis-Sandoz, Pfizer, UCB

scholarly journals Thrombocytosis as a prognostic factor in polymyalgia rheumatica: characteristics determined from cluster analysis

2019 ◽  
Vol 11 ◽  
pp. 1759720X1986482 ◽  
Author(s):  
Keigo Hayashi ◽  
Keiji Ohashi ◽  
Haruki Watanabe ◽  
Ken-Ei Sada ◽  
Kenta Shidahara ◽  
...  
Keyword(s):  
Cluster Analysis ◽  
Treatment Response ◽  
Hierarchical Cluster Analysis ◽  
Polymyalgia Rheumatica ◽  
Clinical Course ◽  
Hierarchical Cluster ◽  
Secondary Outcome ◽  
Peripheral Arthritis ◽  
Significant Difference ◽  
Cluster 2

Background: This study aimed to identify the clinical subgroups of polymyalgia rheumatica (PMR) using cluster analysis and compare the outcomes among the identified subgroups. Methods: We enrolled patients with PMR who were diagnosed at Okayama University Hospital, Japan between 2006 and 2017, met the 2012 European League Against Rheumatism/American College of Rheumatology provisional classification criteria for PMR, and were treated with glucocorticoids. Hierarchical cluster analysis using variables selected by principal component analysis was performed to identify the clusters. Subsequently, the outcomes among the identified clusters were compared in the study. The primary outcome was treatment response at 1 month after commencement of treatment. The secondary outcome was refractory clinical course, which was defined as the requirement of additional treatments or relapse during a 2-year observational period. Results: A total of 61 consecutive patients with PMR were enrolled in the study. Their mean age was 71 years, and 67% were female. Hierarchical cluster analysis revealed three distinct subgroups: cluster 1 ( n = 14) was characterized by patients with thrombocytosis (all patients showed a platelet count of >45 × 10⁴/µl), cluster 2 ( n = 38), by patients without peripheral arthritis, and cluster 3 ( n = 9), by patients with peripheral arthritis. The patients in cluster 1 achieved treatment response less frequently than those in cluster 2 (14% versus 47%, p = 0.030). Refractory cases were more frequent in cluster 1 than in cluster 2; however, no significant difference was noted (71% versus 42%, p = 0.06). Conclusions: Thrombocytosis could predict the clinical course in patients with PMR.

scholarly journals Echocardiographic phenotypes of patients with sickle cell disease. An unsupervised analysis based on etendard cohort

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
T D"humieres ◽  
J Inamo ◽  
S Deswarte ◽  
T Damy ◽  
G Loko ◽  
...  
Keyword(s):  
Cluster Analysis ◽  
Cardiac Output ◽  
Sickle Cell Disease ◽  
Diastolic Function ◽  
Sickle Cell ◽  
Left Ventricular ◽  
Integrative Approach ◽  
Cell Disease ◽  
Clinical Profiles ◽  
Cluster 2

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): PHRC Backgroung Echocardiography is the cornerstone in the diagnosis of cardiopulmonary involvement in sickle cell disease (SCD). However, given the unique pathophysiology of SCD associating high cardiac output, and various degrees of peripheral vasculopathy, differentiate the pathological from the physiological using echocardiography can be particularly challenging. Purpose This study sought to link cardiac phenotypes in homozygous SCD patients with clinical profiles and outcomes using cluster analysis. Methods We analyzed data of 379 patients with a sufficient echographic dataset included in the French Etendard Cohort, a prospective cohort initially designed to assess the prevalence of pulmonary hypertension. A cluster analysis was performed on echocardiographic variables, and the association between clusters and clinical profiles and outcomes was assessed. Results Three clusters were identified. Cluster 1 (N = 122) patients had the lowest cardiac output, only mild left cavities remodeling, diastolic dysfunction, and high tricuspid regurgitation velocity (TRV). They were predominantly female, as old as cluster 2, and displayed the most severe functional limitation. Cluster 2 (N = 103) patients had the highest cardiac output, left ventricular mass and a severely dilated left atrium. Diastolic function and TRV were similar to cluster 1. These patients had a higher blood pressure and a severe hemolytic anemia. Cluster 3 (N = 154) patients had mild left cavities remodeling, the best diastolic function and the lowest TRV. They were younger patients with the highest hemoglobin and lowest hemolytic markers. Right heart catheterization was performed in 94 patients. Cluster 1 gathered the majority of precapillary PH while cluster 2 gathered postcapillary PH and no PH was found in cluster 3. After a follow-up of 9.9 years (IQR: 9.3 to 10.5 years) death occurred in 38 patients (10%). Clusters 2 had the worst prognosis with 18% mortality rate vs. 12% in cluster 2 and 5% in cluster 1 (P log-rank = 0,02). Results are summarized in the central illustration. Conclusions Cluster analysis of echocardiographic variables identified 3 phenotypes among SCD patients, each associated with different clinical features and outcome. These findings underlines the necessity to rethink echocardiographic evaluation of SCD patients, with an integrative approach based on simultaneous evaluation of TRV along with left cavities remodeling and diastolic parameters. Abstract Figure.

scholarly journals Changes in contraception use among Brazilian women after childbirth, 2006-2013

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Felisbino-Mendes ◽  
B Barrozo Siqueira
Keyword(s):  
Health System ◽  
Secondary Data ◽  
Reproductive Age ◽  
Cross Sectional ◽  
Regional Inequalities ◽  
Unified Health System ◽  
Contraception Use ◽  
High Prevalence ◽  
Modern Methods ◽  
Low Prevalence

Abstract Introduction There are gaps in knowledge regarding the neglected and vulnerable subgroups of FP actions in Brazil, such as postpartum women and women in general, regardless of their marital status. Objective To assess changes in the prevalence of use and in the contraceptive pattern of Brazilian women up to two years after pregnancy, between 2006 and 2013. Methods Cross-sectional, descriptive and analytical study which used secondary data from national surveys. We studied Brazilian women with up to 2 years postpartum, of reproductive age, sexually active, non-pregnant and menstruating, and compared them with all the other women. We estimated the prevalence of use, contraception pattern of contraception and ranking of modern methods. Percentual change in indicators between the years was evaluated by calculating the difference between estimates. Results 85% of Brazilian women used CM, remaining stable in 2006 and 2013, with a high prevalence of modern methods use. An increase in the use of CM was observed among those with up to six months postpartum (71.0% to 89.0%). Pills and condoms accounted for about 60% of modern methods used in the postpartum period in both surveys. There was an increase in dual protection (2.9% to 10.1%) and contraceptive insecurity (1.6% to 5.7%) and a reduction in sterilization (16.2% to 13.4%) and traditional methods (2.1% to 1.4%). Conclusions Even with the maintenance of a high prevalence of use of CM and with the increase in contraception among women with up to six months postpartum, regional inequalities in access to CM and low prevalence of the use of other methods made available by the Unified Health System (SUS) persist, pointing out the maintenance of the insufficient care, failures in the means to regulate fertility and that public policies still hinder to guarantee the sexual and reproductive rights of the most vulnerable population. Key messages Regional inequalities in access to contraceptive methods and low prevalence of other methods made available by the Unified Health System (SUS) persist. There was an increase in contraception use among women with up to six months postpartum in Brazil.

scholarly journals Low Prevalence of Pneumocystis pneumonia (PCP) but High Prevalence of Pneumocystis dihydropteroate synthase (dhps) Gene Mutations in HIV-Infected Persons in Uganda

PLoS ONE ◽  
2012 ◽  
Vol 7 (11) ◽  
pp. e49991 ◽  
Author(s):  
Steve M. Taylor ◽  
Steven R. Meshnick ◽  
William Worodria ◽  
Alfred Andama ◽  
Adithya Cattamanchi ◽  
...  
Keyword(s):  
Gene Mutations ◽  
Pneumocystis Pneumonia ◽  
Dihydropteroate Synthase ◽  
High Prevalence ◽  
Dhps Gene ◽  
Low Prevalence

scholarly journals Prevalence of ColE1-Like Plasmids and Colicin K Production among Uropathogenic Escherichia coli Strains and Quantification of Inhibitory Activity of Colicin K

2006 ◽  
Vol 73 (3) ◽  
pp. 1029-1032 ◽  
Author(s):  
Matija Rijavec ◽  
Maruška Budič ◽  
Peter Mrak ◽  
Manica M�ller-Premru ◽  
Zdravko Podlesek ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Inhibitory Activity ◽  
Insertion Sequence ◽  
Uropathogenic Escherichia Coli ◽  
Mosaic Structure ◽  
High Prevalence ◽  
Low Prevalence

ABSTRACT Colicin K exhibited pronounced inhibitory activity against uropathogenic Escherichia coli (UPEC) strains. Low prevalence of colicin K production and a relatively high prevalence of ColE1-like plasmids were determined among 215 UPEC strains from Slovenia. Sequencing of the colicin K-encoding pColK-K235 revealed a mosaic structure and the presence of the insertion sequence IS2.

scholarly journals Could clustering of comorbidities be useful for better defining the internal medicine patients’ complexity?

2018 ◽  
Vol 12 (2) ◽  
pp. 137 ◽  
Author(s):  
Flavio Tangianu ◽  
Paola Gnerre ◽  
Fabrizio Colombo ◽  
Roberto Frediani ◽  
Giuliano Pinna ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Decision Making ◽  
Cluster Analysis ◽  
Adverse Events ◽  
Decision Making Process ◽  
High Similarity ◽  
High Prevalence ◽  
Clinical Problems ◽  
Index Disease ◽  
Improve Health

Internal medicine patients are mostly elderly with multiple comorbidities, usually chronic. The high prevalence of comorbidity and multimorbidity has a significant impact on both positive responses to treatment and the occurrence of adverse events. Clustering is the process of nosography grouping into meaningful associations with some index disease, so that the objects within a cluster have high similarity in comparison with one another. In the decision-making process it is imperative that, in addition to understanding the immediate clinical problems, we are able to explicit all the contextual factors that have to be taken into account for the best outcome of care. Cluster analysis could be leveraged in developing better interventions targeted to improve health outcomes in subgroups of patients.

Evaluation of a gait scoring system for cattle by using cluster analysis and Krippendorff’s α reliability

2018 ◽  
Vol 184 (7) ◽  
pp. 220-220 ◽  
Author(s):  
Nina Volkmann ◽  
Jenny Stracke ◽  
Nicole Kemper
Keyword(s):  
Cluster Analysis ◽  
Dairy Cows ◽  
Scoring System ◽  
Partial Agreement ◽  
Claw Lesions ◽  
Cluster 2 ◽  
Locomotion Score

The aim of the presented study was to validate a three-point locomotion score (LS) classifying lameness in dairy cows. Therefore, locomotion of 144 cows was scored and data on claw lesions were collected during hoof trimming. Based on latter data a cluster analysis was performed to objectively classify cows into three groups (Cluster 1–3). Finally, the congruence between scoring system and clustering was tested using Krippendorff’s α reliability. In total, 63 cows (43.7 per cent) were classified as non-lame (LS1), 38 (26.4 per cent) were rated as LS2 with an uneven gait and 43 (29.9 per cent) cows were ranked as clearly lame (LS3). In comparison, hoof-trimming data revealed 64 cows (44.4 per cent) to show no diagnosis, 37 (25.7 per cent) one diagnosis, 33 animals (22.9 per cent) two diagnoses and 10 (7.0 per cent) more than two. Comparing the respective categorisation received by either the cluster analysis or LS in between groups, a high correspondence (79.4 per cent and 83.7 per cent) could be found for LS1 and cluster 1 as well as for LS3 and cluster 3. Only LS2 had partial agreement (21.1 per cent) to cluster 2. However, Krippendorff’s α was 0.75 (95 per cent CI 0.68 to 0.81), indicating a good degree of reliability. Therefore, the results of this study suggested that the presented LS is suitable for classifying the cows’ state of lameness representing their claw diseases.

scholarly journals A Comparison of Mental Health Outcomes in the United States and Italy at Different Levels of Cumulative COVID-19 Prevalence

2021 ◽  
Author(s):  
Anthony D Mancini ◽  
Gabriele Prati
Keyword(s):  
Mental Health ◽  
United States ◽  
New York ◽  
San Francisco ◽  
The United States ◽  
Ptsd Symptoms ◽  
General Distress ◽  
High Prevalence ◽  
Low Prevalence ◽  
Different Levels

How does the prevalence of COVID-19 impact people’s mental health? In a preregistered study (N = 857), we sought to answer this question by comparing demographically matched samples in four regions in the United States and Italy with different levels of cumulative COVID-19 prevalence. No main effect of prevalence emerged. Rather, prevalence region had opposite effects, depending on the country. New York City participants (high prevalence) reported more general distress, PTSD symptoms, and COVID-19 worry than San Francisco (low prevalence). Conversely, Campania participants (low prevalence) reported more general distress, PTSD symptoms, and COVID-19 worry than Lombardy (high prevalence). Consistent with these patterns, COVID-19 worry was more strongly linked with general distress and PTSD symptoms in New York than San Francisco, whereas COVID-19 worry was more strongly linked with PTSD in Campania than Lombardy. In exploratory analyses, media exposure predicted and mapped on to geographic variation in mental health outcomes.

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