Chasing the Ghost of Imaging Remission in Rheumatoid Arthritis
Bibliographic record
Abstract
The role of musculoskeletal ultrasound (MSK-US) in rheumatoid arthritis (RA) is evolving, albeit with twists and turns. Early RA randomized clinical studies have demonstrated little added value of MSK-US when used prospectively in a treat-to-target strategy1,2. Recent editorials have discussed the issues of clinical trial design and standardization US measures raised by these studies3,4. Ostensibly the goal of therapy in RA is to achieve remission and hence halt progression of erosions, as well as to maintain function. However, sustained remission is not obtained in the majority of patients with established RA5. Further, despite more stringent composite and Boolean remission criteria, progression of erosions still occurs regardless of applied clinical remission criteria6,7,8. Progression of erosions in subjects in remission is considered a result of subclinical synovitis. MSK-US can be used at the bedside to gauge residual synovitis in many joint areas. In metaanalyses of heterogeneous RA populations in clinical remission, the prevalence of greyscale and Doppler-positive subjects was estimated at 43%9. Residual synovitis prevalence was comparable even when using alternate definitions of remission. Power Doppler seems to be the key component of imaging synovitis linked to progression of erosions9,10. Of note in the 4 studies included for structural progression, definition of progression ranged from change of total Sharp score of greater than zero to greater than the smallest detectable difference9,10. In addition, prevalence of residual synovitis was higher in patients … Address correspondence to Dr. G.S. Kaeley, University of Florida College of Medicine, Division of Rheumatology, PO Box 162, Ponte Vedra, Florida 32004, USA. E-mail: drgurj{at}gmail.com
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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 | 0.149 | 0.323 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.002 |
| Bibliometrics | 0.005 | 0.004 |
| Science and technology studies | 0.002 | 0.007 |
| Scholarly communication | 0.008 | 0.013 |
| Open science | 0.004 | 0.005 |
| Research integrity | 0.008 | 0.020 |
| 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".