Is it ever lupus? A single centre retrospective review of the rheumatologic work-up in patients with clinically isolated syndrome (P6.113)
Bibliographic record
Abstract
Objective: To investigate the role of rheumatologic testing in patients with clinically isolated syndrome (CIS). Background: CIS refers to an initial demyelinating event suspicious for multiple sclerosis (MS), without sufficient evidence of dissemination in time and space to diagnose MS. The value of testing patients with CIS for rheumatologic disease is unclear. Design/Methods: Charts of 154 CIS patients referred to our MS clinic were reviewed for ANA, ENA, ds-DNA, C3/C4, RF, and/or aPLA testing. We excluded patients who already met criteria for MS, were not CIS (e.g. stroke), had positive anti-NMO, had no rheumatologic testing done, had known prior rheumatologic disease, were under 18 or were followed for less than 1 year. Results: Fifty-six patients met inclusion criteria. Mean age was 37.5 years, and 71[percnt] were female. Over a mean follow-up of 4.7 years, 25[percnt] converted to MS. Of patients tested for ANA, 34/53 (64[percnt]) were weakly/moderately positive, but none were strongly positive (titre >1:80). Of ANA-positive patients, 26[percnt] converted to MS, compared to 26[percnt] of ANA-negative patients. Regarding more specific lupus markers, only 2/48 (4[percnt]) tested for ds-DNA were positive, and 0/20 tested had low C3/C4. Of patients tested for ENA, 0/46 were positive. RF was positive in 1/34 patients (3[percnt]). Of patients tested for anti-cardiolipin antibodies, 2/35 (6[percnt]) were positive. One patient with psoriasis developed psoriatic arthritis, but no patient was diagnosed with lupus, Sjogren's, antiphospholipid antibody syndrome, or any other autoimmune rheumatologic disease. Conclusions: In our single centre review of patients with CIS who underwent rheumatologic testing, ANA was weakly/moderately positive in 64[percnt] and did not aid in predicting diagnosis of MS versus an autoimmune rheumatologic disease. More specific rheumatologic markers, including ds-DNA, ENA, low C3/C4 and antiphospholipid antibodies were rarely positive, and no CIS was attributed to a newly diagnosed rheumatologic disease.
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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 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
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".