Prediction of Response to Therapies and Flares Based on Ultrasound Findings at Baseline in Psoriatic Arthritis: An Analysis on a Joint Level
Notice bibliographique
Résumé
Objectives It is not clear how to interpret when the ultrasound and physical examination do not agree on a joint level. In this study, we aimed to investigate, within PsA patients who are about to start an advanced therapy: a) the likelihood of achieving a good response; b) the risk of experiencing a flare, on a joint level, 3 months post-therapy, based on the baseline ultrasound inflammation. Methods At the ORCHESTRA (Ottawa Rheumatology CompreHEnSive TReatment and Assessment) Clinic, PsA patients starting a new advanced therapy are assessed using a protocolized US scan. Patients are evaluated in the same clinic for 3 months after therapy initiation. For this analysis, all MCP, PIP, DIP, and wrist joints were included; and analysis was performed on a joint level. US findings at baseline were scored for grayscale synovitis, Doppler signals and Global OMERACT-EULAR Synovitis Score (GLOESS) on scale of 0-3; grade ≥2 being considered positive. Physical exam was conducted at baseline and at 3-months, documenting the tenderness and/or swelling. For prediction of response, joints that were tender and/or swollen at baseline were included in the analysis. For prediction of flares, joints that were not tender and/or swollen at baseline were analyzed. Odds ratios were calculated to determine response and flare rates. Results The analysis included 36 PsA patients (61.1% female) with a mean (SD) age of 50 (12.7). At baseline, 17 patients (47.2%) were bionaïve, while 19 (52.8%) patients had failed 1 or more biologic therapies. A total of 1079 joints were analyzed, 333 (30%) being tender, 151 (14%) being swollen, and 365 (34%) being tender and/or swollen at baseline. Symptomatic joints with high inflammation on US at baseline had a lower response rate (less likely to become asymptomatic) at follow-up) than those without (OR range 0.30-0.66) (Table). Asymptomatic joints at baseline were more likely to flare (become symptomatic at follow-up) if their baseline US inflammation was higher (OR range 1.06-4.73). For both outcomes, the swelling had higher associations than the tenderness of the joint (Table). Table: Response and flare rates based on tender and/or swollen joints at baseline, according the initial US-positivity. Conclusion Our study shows 2 critical implications of positive baseline US findings on a joint level: a) Tender and/or swollen joints with positive US findings are more resistant to therapies compared to those without, and b) non-tender and/or non-swollen joints with positive US findings have a higher risk of developing symptoms. Although the integration of US findings into treatment algorithms is uncertain, they indicate the presence of a distinct patient phenotype.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,008 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».