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Comment to: Cluster analysis for clinical sarcoidosis' phenotyping

  • Manuel Rubio-Rivas
    Correspondence
    Corresponding author.
    Affiliations
    Autoimmune Diseases Unit, Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain
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  • Xavier Corbella
    Affiliations
    Autoimmune Diseases Unit, Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain

    School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain

    Group of Evaluation of Health Determinants and Health Policies, Hestia Chair in Integrated Health and Social Care, Barcelona, Spain
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      We have read and appreciated the commentary by M. d'Alessandro to our manuscript entitled “Cluster analysis for clinical sarcoidosis’ phenotyping” published in European Journal of Internal Medicine [
      • D’Alessandro M.
      Cluster analysis for clinical sarcoidosis’ phenotyping.
      ]. We agree that phenotyping sarcoidosis patients is important for clarifying prognosis and therapeutic approaches. Since ethnicity, sex, genetic background, environmental exposures or socioeconomic status may play an important role in sarcoidosis, several attempts have been previously published showing a wide range of phenotypic variability. The aim of our investigation was to distinguish clinical phenotypes of sarcoidosis in our Spanish population by combining traditional signs and symptoms [
      • Rubio-Rivas M.
      • Corbella X.
      Clinical phenotypes and prediction of chronicity in sarcoidosis using cluster analysis in a prospective cohort of 694 patients.
      ]. It is evident that sarcoidosis population in Spain is mostly Caucasian, where approximately half of them present in the form of Löfgren's syndrome typically. In accordance with M. D'Alessandro, the six phenotype clusters emerged in our study may not apply in other racial groups such as the African-American or Japanese populations, with poor presence of Löfgren's syndrome, and cannot be generalized. For the same reason, phenotypic classification in such African-American or Japanese populations cannot be generalized in our population. This is why we believe that our results may help the clinical approach of sarcoidosis among European populations, in which Caucasians are represented in large proportion. In this regard, further studies assessing biological markers and genotypes may help each area or country to choose what clinical phenotype classification better suits its population characteristics and disease process.

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      References

        • D’Alessandro M.
        Cluster analysis for clinical sarcoidosis’ phenotyping.
        Eur J Intern Med. 2020; (DOI: IN PRESS)
        • Rubio-Rivas M.
        • Corbella X.
        Clinical phenotypes and prediction of chronicity in sarcoidosis using cluster analysis in a prospective cohort of 694 patients.
        Eur J Intern Med. 2020 Apr 21; https://doi.org/10.1016/j.ejim.2020.04.024