Anti-RNA Polymerase III Antibodies as a Risk Marker for Early Gastric Antral Vascular Ectasia (GAVE) in Systemic Sclerosis
Bibliographic record
Abstract
We read with the greatest interest the recent article by Ingraham et al, on predictors of gastric antral vascular ectasia (GAVE) in systemic sclerosis (SSc) 1 .In a series of 28 patients with GAVE, only 1 patient was positive for anti-topoisomerase I (topo I), whereas 1 patient had anti-RNA polymerase III (RNAP III) antibodies, and 4 (all with rapidly progressive diffuse cutaneous involvement) had a speckled antinuclear antibody (ANA) pattern.These 4 patients were not tested for anti-RNAP III antibodies, but the authors considered likely that the patients in this group would have anti-RNAP III because of their typical clinical appearance and the absence of anti-topo I.They also reported that, in their clinical practice, another 4 patients with diffuse cutaneous SSc and GAVE were found to be anti-RNAP III positive.For these reasons, they raised the suggestion that anti-RNAP III antibodies may act as predictors for early development of GAVE in SSc patients 1 .We recently reported the clinical data of a series of anti-RNAP III positive SSc patients followed in our center 2 .Interestingly, 3 out of 18 (16.7%)anti-RNAP III positive SSc patients had been diagnosed with GAVE 2 .This proportion is relatively high, considering that GAVE prevalence was estimated at 5.7% in a population of 264 consecutive patients with SSc 3 , and suggests a possible predictive role of anti-RNAP III antibodies, as reported by Ingraham, et al.In order to verify the hypothesis that anti-RNAP III and anti-topo I antibodies are associated with different risk for early GAVE in SSc patients, we reevaluated the clinical charts of 453 consecutive patients with SSc and anti-RNAP III or anti-topo I antibodies.More than 99% of patients were Caucasian.The presence of GAVE was identified through endoscopic visual evidence in patients with SSc and unexplained iron deficiency anemia.Anti-topo I were detected by counterimmunoelectrophoresis and anti-RNAP III by ELISA.Sixteen patients with isolated anti-RNAP III antibodies (16/453; 3.5%) and 101 patients with anti-topo I (101/453; 22.2%) were identified.Three additional patients with anti-RNAP III in combination with other antinuclear specificities (anti-NOR90, anti-topo I, anti-centromere, one case each) were excluded, due to the confounding effect of the double antinuclear specificity.Patients with anti-RNAP III antibodies had more rapid disease onset, defined as the interval from appearance of Raynaud's phenomenon to first symptom other than Raynaud's (p = 0.0013).They also had faster skin thickening in the first months after SSc onset (p = 0.0002), in comparison with anti-topo I positive SSc patients.
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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) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.009 | 0.005 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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".