Spondyloarthritis Among Patients With Uveitis: Can We Improve Referral Pathways?
Bibliographic record
Abstract
Delays in diagnosis remain a major gap in the care of patients with axial spondyloarthritis (axSpA). Despite efforts to improve awareness among family physicians and nonrheumatologist specialists, the average duration from onset of symptoms to diagnosis of axSpA is approximately 8 years,1 which is one of the longest in rheumatology. Such delays in diagnosis are associated with late initiation of therapy and worse disease outcomes. Acute anterior uveitis (AAU), the most common extraarticular manifestation in SpA, affects 50% of patients and has been associated with longer delays in diagnosis.2 For many patients, AAU is the first encounter with a medical specialist, offering a unique opportunity for an early referral to rheumatology. Thus, studying the association between these 2 conditions could inform the development of more effective referral pathways from ophthalmology to rheumatology, ultimately improving early diagnosis of axSpA. In this edition of The Journal of Rheumatology, van Bentum et al describe the effect of an initiative aimed to increase awareness and referrals to rheumatology of patients with AAU and chronic back pain (CBP) seen in academic and community ophthalmology centers in Amsterdam.3 The referral criteria comprised an accepted definition of CBP (back pain of ≥ 3 months’ duration that started prior to the age of 45 years) among patients with new or recurrent AAU. All patients were assessed by a rheumatologist for clinical signs and symptoms of axSpA. Additionally, radiographic assessment of the sacroiliac joints was performed and HLA-B27 status determined in all patients. Magnetic resonance imaging (MRI) of the spine was performed only if deemed clinically necessary for diagnostic purposes. Among patients with AAU and CBP, the study found a prevalence of 23% (19 out of 81 patients) for previously undiagnosed axSpA, which was almost … Address correspondence to Dr. L. Eder, 76 Grenville Street, Women’s College Hospital, Toronto, ON M5S 1B2, Canada. Email: Lihi.eder{at}wchospital.ca.
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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 | 0.005 | 0.036 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.005 | 0.006 |
| Open science | 0.003 | 0.004 |
| Research integrity | 0.004 | 0.005 |
| Insufficient payload (model declined to judge) | 0.013 | 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".