Value of the Multibiomarker Disease Activity Score to Predict Remission in RA: What Does the Evidence Show?
Bibliographic record
Abstract
The achievement of true full clinical remission of rheumatoid arthritis (RA) is the goal of both patients and rheumatologists. There still is much discrepancy, with resulting confusion, in how remission is defined despite the consensus reached by the American College of Rheumatology and the European League Against Rheumatism that the most reliable definition of true remission is either a Boolean definition or a Simplified Disease Activity Index (SDAI) score < 3.31. Other proposed remission cutoffs, including those for Disease Activity Score (DAS), 28-joint DAS (DAS28), and Routine Assessment of Patient Index Data 3 (RAPID-3), are much less stringent, and thus allow far more patients to be considered as having achieved “remission” despite the possibility of continued active disease in the joints with systemic inflammation (Figure 1)2. The accurate measurement of disease activity with a fully validated instrument is a key component of RA management. Figure 1. Relationship between disease measures defining remission in the AMPLE trial (Abatacept Versus Adalimumab Comparison in Biologic-Naive RA Subjects with Background Methotrexate). Each of the diagrams shows the percentage of patients achieving either DAS28-CRP < 2.6 (“remission”) or RAPID-3 “remission,” and of those, the percentage of patients who achieved Boolean, SDAI, or CDAI remission. Panels A–D: SC abatacept + MTX arm. Panels E–H: SC adalimumab + MTX. RA: rheumatoid arthritis; DAS28-CRP: 28-joint Disease Activity Score using C-reactive protein; RAPID-3: Routine Assessment of Patient Index Data 3; Boolean: Boolean remission; SDAI: Simple Disease Activity Index; CDAI: Clinical DAI; SC: subcutaneous; MTX: methotrexate. Over the past decade there has been much interest in the discovery of biomarkers that can identify the complex and heterogeneous biology of RA and have the ability to reliably demonstrate the absolute degree of disease activity, both peripherally and systemically, in all patients. One instrument, which has claimed to be … Address correspondence to Dr. R. Fleischmann, 8144 Walnut Hill Lane, Suite 810, Dallas, Texas 75231, USA. E-mail: rfleischmann{at}arthdocs.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 | 0.044 | 0.055 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.007 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.001 | 0.003 |
| Scholarly communication | 0.005 | 0.005 |
| Open science | 0.005 | 0.002 |
| Research integrity | 0.006 | 0.006 |
| Insufficient payload (model declined to judge) | 0.006 | 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".