Beyond Early Diagnosis: Occult Psoriatic Arthritis
Bibliographic record
Abstract
Psoriatic arthritis (PsA) is a heterogeneous disease involving the skin and nails and different musculoskeletal structures including synovial joints, entheses, synovial sheaths of tendons, and the axial skeleton1. Therefore, its clinical spectrum is broad and each clinical rheumatological manifestation can occur for a long time in isolation2. PsA should be diagnosed early because the major goals of management, reduction of pain, improvement of function, and inhibition of joint damage, can best be achieved by early intervention3–6. For identification of PsA, in either rheumatological or dermatological settings, it seems obvious that the patient must have symptoms and signs of musculoskeletal involvement. A recent study from Germany that analyzed 2009 patients with psoriasis from 13 dermatological hospitals and 129 dermatological private practices showed that in developed countries there is still a significant number of undiagnosed persons with PsA7. However, many dermatologists have time restrictions that make it impossible to routinely search for musculoskeletal symptoms. Screening tools to be filled in by the patient in the waiting room or at home have been suggested for identification of these inflammatory manifestations8–11. Since the 1970s, it has been recognized that each inflammatory lesion (joint synovitis, tenosynovitis, dactylitis, enthesitis, sacroiliitis, and spondylitis) can develop without symptoms or signs that are recognizable by the patient and the physician. Such patients can be considered to have subclinical or “occult” PsA. Their identification represents a further challenge for rheumatology. The prevalence of psoriasis in the general population has been estimated to be between 2% and 3%. The estimated prevalence of manifest PsA among patients with psoriasis has varied widely from 6% to 42%. Studies from Sweden and Italy suggest that evident PsA occurs in about one-third of patients with psoriasis12,13. If … Address correspondence to Dr. I. Olivieri, Rheumatology Department of Lucania, Ospedale San Carlo, Contrada Macchia Romana, 85100 Potenza, Italy. E-mail: ignazioolivieri{at}tiscalinet.it
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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 | 0.010 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.003 | 0.004 |
| 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".