Rheumatoid Arthritis in the 21st Century: Treatment Patterns and Disease Activity States
Bibliographic record
Abstract
The treatment of rheumatoid arthritis (RA) has dramatically changed in the past 2 decades, with emphasis placed on prompt diagnosis and treatment aiming for early and sustained remission. The concept of “treat to target” (T2T) represents a therapeutic paradigm of modern rheumatology practice and there exists a strong evidence base supporting early and intensive therapeutic approaches to target and eradicate inflammation. This has been possible with new, improved treatments and combination regimens1,2,3,4. However, while inflammation can be reversed, the extent of reversibility of disease outcomes such as joint destruction and functional capacity is dependent both on the duration and degree of inflammation. The timing of intervention is thus important, highlighting an important aspect of disease: the early phase of RA and the therapeutic “window of opportunity.”5 The latter is supported by many observations on disease course and outcomes, including progression of radiographic damage and reduced opportunity for disease-modifying antirheumatic drug (DMARD)-free sustained remission with prolonged symptom duration6. In this issue of The Journal , Littlejohn and colleagues report on disease activity trends in RA based on 5-year data (2009–2014) from the OPAL-QUMI (Optimising Patient outcome in Australian Rheumatology-Quality Use of Medicines Initiative) study7, a multicenter, cross-sectional, non-interventional study of patients with RA treated in Australia. Although predominantly descriptive, their study is highly relevant and informative regarding conventional, real-world rheumatology practice, treatment strategies, and disease activity states. Almost 9000 patients were included in the study, with age and sex distributions typical of RA cohorts. The high number of patients and participating rheumatologists are an important strength of the study. Over 37,000 Disease Activity Score 28-erythrocyte sedimentation rate (DAS28-ESR) test results were available, with the largest part (46.2%) falling in the remission … Address correspondence to Prof. T. Sokka, Jyväskylä Central Hospital, 40620 Jyväskylä, Finland. E-mail: tuulikki.sokka-isler{at}ksshp.fi
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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 | 0.003 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.004 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 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".