Pain in Axial Spondyloarthritis: More to It Than Just Inflammation
Bibliographic record
Abstract
The conceptual paradigm of axial spondyloarthritis (axSpA) has evolved and now comprises an expanded spectrum that includes more females and patients with little or no radiographic changes in sacroiliitis or syndesmophyte formation in the spine.1 This broadened paradigm is often, but not always, characterized by an inflammatory magnetic resonance imaging (MRI) signature. Multiple studies have demonstrated a similar burden of symptoms, physical dysfunction, and disability across the full spectrum of disease presentation, regardless of the presence of radiographic damage, including pain.2,3,4 Does the pain experienced by these patients only represent a summation of arthritis, enthesitis, and osteitis, both axial and peripheral (i.e., purely induced by inflammation and structural damage), or could there be broader pathologic processes that contribute to and amplify the pain experience? Studies have shown that in a substantial proportion of patients with axSpA, as well as other chronic inflammatory diseases,5 some of the pain and other symptoms such as fatigue represent fibromyalgia (FM) or analogous terminology: chronic widespread pain (CWP), central sensitization, “fibromyalgianess,” or the newest term, “nociplastic pain.”6 The conditions these terms denote are not fully synonymous, but all allude to the phenomenon of increased nociception mediated through the central nervous system. The proportion of pain that is mediated by the underlying inflammatory condition, the “-itis”, vs the centrally mediated pain condition, the “-algia,” often varies depending upon such factors as the patient’s sex, the effectiveness of immunomodulatory treatment of the inflammatory disease, disease duration, genetic risk for central sensitization, and other contextual factors.7 Since the degree of central pain can confound our ability to measure the degree of inflammatory pain, how can we more accurately assess their relative contributions so as not to undertreat or mistreat the “-itis” component and overtreat or mistreat the “-algia” component? … Address correspondence to Dr. M.N. Magrey, 2500 MetroHealth Drive, Cleveland, OH 44109, USA. Email: mmagrey{at}metrohealth.org.
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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 | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.007 |
| Scholarly communication | 0.005 | 0.007 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.004 | 0.006 |
| Insufficient payload (model declined to judge) | 0.005 | 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".