Amyloidosis and Giant Cell Arteritis/Polymyalgia Rheumatica
Bibliographic record
Abstract
To the Editor: Secondary amyloidosis can develop in a patient with seemingly quiescent giant cell arteritis/polymyalgia rheumatica (GCA/PMR). We describe a patient with clinically quiescent GCA who developed AA amyloidosis of the kidney, resulting in nephrotic syndrome and acute renal failure. A 79-year-old woman presented to the rheumatology service in December 2009 with new-onset unilateral headache and prominence and tenderness of the left temporal artery. Erythrocyte sedimentation rate (ESR) was 85 mm/h and C-reactive protein (CRP) was 40.9 mg/l. She fulfilled 4 of the 5 American College of Rheumatology (ACR) 1990 criteria for GCA: age > 50 years, new-onset headache, temporal artery abnormality, and ESR > 50 mm/h1. She denied symptoms of PMR but she had anorexia and generalized fatigue that had been persistent for several years. Subsequent investigations for GCA included left-side temporal artery biopsy of 1 cm and magnetic resonance imaging (MRI) of the scalp vessels with contrast. The temporal artery biopsy was negative for evidence of arteritis; however, the MRI showed abnormal enhancement in the superficial temporal artery in the postcontrast images. This finding was felt to be diagnostic of arteritis. The patient had a 35 pack-years smoking history with moderate chronic obstructive pulmonary disease (COPD) and a history of tuberculosis treated in 1951 with residual right-upper lobe traction bronchiectasis, demonstrable on computerized tomography (CT) scan. She experienced on average 1 infectious exacerbation per year and in the intervening period had no baseline sputum production. She also had hypertension, paroxysmal atrial fibrillation, and hypothyroidism. She was initially treated for GCA with prednisone 50 mg daily for 3 weeks, with complete resolution … Address correspondence to Dr. Legault; E-mail: kimberly.legault{at}medportal.ca
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.012 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.011 | 0.009 |
| Insufficient payload (model declined to judge) | 0.004 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".