Definition of Treatment Targets in Rheumatoid Arthritis: Is It Time for Reappraisal?
Bibliographic record
Abstract
In the current issue of The Journal of Rheumatology , Kremer and colleagues1 compare the Clinical Disease Activity Index (CDAI) with a slightly modified Corrona Routine Assessment of Patient Index Data 3 (cRAPID3) in terms of correlation and disease activity categorization, using 2 large US registries of patients with rheumatoid arthritis (RA). Overall, a low concordance between these 2 composite indices (κ = 0.29) was found in terms of disease activity categories, despite a moderate correlation between their numerical global scores (rs = 0.58 and 0.72, for the BRASS and CORRONA registries, respectively). The authors provided a correlation matrix of the individual components of these indices, confirming an overall low (rs ≤ 0.50) agreement between physician- and patient-derived domains. The agreement in the classification of patients according to disease activity categories was poor: 34% of all patients in remission or low disease activity (LDA) according to CDAI (n = 28,991) in the CORRONA registry were classified as moderate or high disease activity by cRAPID3. Conversely, among all patients in a “satisfactory” state according to cRAPID3 (n = 22,201), 14% did not reach the target of remission or LDA by the CDAI. The authors concluded that “RAPID3 should not be used as an exclusive measure to evaluate clinical status and inform treatment decisions as the individual components of this metric are highly associated with noninflammatory conditions…and are discordant with CDAI evaluations.”1 These results are striking in a treat-to-target (T2T) era and justify the authors’ conclusion. Treating to target has become a predominant paradigm in the management of RA, supported by statistical evidence of superior efficacy and better long-term outcomes.2,3 The provisional definitions of remission, the primary target, endorsed by the American College of Rheumatology and the European Alliance of Associations for Rheumatology (ACR/EULAR)4 … Address correspondence to Dr. R.J. Ferreira, Serviço de Reumatologia, Consulta Externa, Piso 7, Centro Hospitalar e Universitário de Coimbra, EPE. Avenida Dr. Bissaya Barreto, 3000-075 Coimbra. Portugal. Email: rferreira@reumahuc.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 | 0.145 | 0.239 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.010 | 0.003 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.003 | 0.013 |
| Scholarly communication | 0.021 | 0.036 |
| Open science | 0.012 | 0.010 |
| Research integrity | 0.016 | 0.050 |
| Insufficient payload (model declined to judge) | 0.003 | 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".