Anti-Cyclic Citrullinated Peptide Antibody versus HAQ/MDHAQ: Comparing Apples and Oranges?
Bibliographic record
Abstract
Pincus, et al in the this issue of The Journal address the contentious issue of where anti-cyclic citrullinated peptide antibody (anti-CCP) testing belongs, if at all, in routine clinical practice1. The extension of this line of thought is whether or not this test is cost-effective or of real clinical utility to the practicing rheumatologist. The authors address the question whether testing for anti-CCP will improve patient outcomes or be of value in making appropriate clinical therapeutic decisions at the bedside above and beyond the evaluation of function in a systematic fashion. They raise the question whether a composite patient-related non-biologically-based score such as the Health Assessment Questionnaire (HAQ)/Multidimensional (MD) HAQ should trump a laboratory test when evaluating a patient with rheumatoid arthritis (RA). While arguing for the use of this test, the authors note that “Anti-CCP provides a significantly higher hazard ratio than rheumatoid factor (RF) to identify people with early arthritis who will develop progressive disease”2,3, based on greater pooled specificity of 95% in a metaanalysis of 37 studies, compared to 85% in 50 studies of RF for RA3. They also argue that the presence of these antibodies may favor the use of treatments that are proven to be highly effective in subsets of patients who are positive for anti-citrullinated peptide antibodies (ACPA), which include anti-CCP4. Perhaps we should not compare apples with oranges, as anti-CCP is a good biomarker predicting sustained inflammatory arthritis and increased risk of erosions in early disease, whereas the HAQ (or other modified versions of the HAQ) is important for evaluating function and can be done repeatedly by the patient. The HAQ, however, does not necessarily perform well in early disease, given that functional impairment early on may be fully reversible5 and is … Address correspondence to Dr. Bykerk; E-mail: vbykerk{at}mtsinai.on.ca
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.006 | 0.037 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.005 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.005 |
| Insufficient payload (model declined to judge) | 0.015 | 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".