Pancytopenia in a Patient with Psoriatic Arthritis Treated with Methotrexate and Concomitant Lithium
Bibliographic record
Abstract
To the Editor: We report a case of pancytopenia in a patient with psoriatic arthritis (PsA) treated with methotrexate (MTX) and concomitant lithium. Our index patient was a 55-year-old white female who had PsA since age 28. She had arthritis mutilans. Her disease was well controlled while being treated with MTX 15 mg weekly together with folic acid 10 mg weekly for many years. She was not receiving any nonsteroidal antiinflammatory drugs because her arthritis was well controlled with disease-modifying agents. Both her psoriasis as well as the PsA were well managed with the above medication. She had been followed up regularly with liver function tests and complete blood count tests every 3 months with no toxicity from the MTX. In March of 2012, she presented to her general practitioner with symptoms suggesting bipolar disorder. Her general practitioner then commenced treatment with lithium 400 mg daily. Two months after the commencement of lithium, the patient presented with epistaxis … Address correspondence to Dr. A. Maharaj, Academic Medical Center, Immunology and Rheumatology, University of Amsterdam, Amsterdam, 1100 DD Amsterd, the Netherlands. E-mail: maharaja30{at}ukzn.ac.za
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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 | 0.001 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.009 | 0.006 |
| 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".