Could Disease Activity Score in 28 Joints–Gamma-glutamyl Transferase Use Improve Cardiovascular Disease Risk Management in Rheumatoid Arthritis?
Bibliographic record
Abstract
Patients with rheumatoid arthritis (RA) experience a markedly increased risk of cardiovascular disease (CVD)1,2,3. Atherogenesis in RA remains poorly elucidated but traditional cardiovascular (CV) risk factors, systemic inflammation and their interactions, as well as genetic components certainly contribute1,2,3. In a recent 13-center study, the population-attributable CV event risk for disease activity as estimated by the Disease Activity Score in 28 joints (DAS28) and positive rheumatoid factor and/or anti cyclic citrullinated peptide antibodies, were both as large as that for lipids in RA4. It is therefore not unexpected that current CVD risk stratification tools calculated based on major traditional CV risk factors, such as the Framingham score and Systematic Coronary Risk Evaluation (SCORE), perform suboptimally in RA1,2,3. Recently developed disease-specific CVD risk calculators may also not perform better than those developed for the general population in predicting CV events in RA5. In this regard, during the past 2 decades, many population studies revealed that circulating gamma-glutamyl transferase (GGT) concentrations within normal ranges relate to major traditional CV risk factors, systemic inflammation, and incident CV events6,7,8,9,10,11,12. In RA, GGT levels were also found to be associated with disease activity markers13. These reported observations suggest that serum GGT concentrations may be useful in the identification of patients with RA who are at increased CVD risk. In this issue of The Journal , Vergneault and colleagues14 explored the associations of circulating GGT levels with CV risk factors in 129 patients with RA. Only patients with unstable hepatic disease and manifestations of liver dysfunction or failure were excluded. GGT concentrations were weakly associated with C-reactive protein … Address correspondence to Dr. P.H. Dessein, Departments of Medicine and Physiology, University of the Witwatersrand Medical School, 7 York Road, Parktown, 2193, Johannesburg, South Africa. Email: patrick.dessein22{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 | 0.003 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.002 | 0.002 |
| 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".