Psoriatic arthritis flare incidence, definition and risk factors: a systematic review
Bibliographic record
Abstract
OBJECTIVES: We systematically reviewed the literature to identify the incidence of PsA flare, criteria used to define it and associated risk factors. METHODS: Databases of Embase, Medline ALL, Web of Science Core Collection and Cochrane Central Register of Controlled Trials were searched until September 2023, for original articles studying PsA flare. The Newcastle-Ottawa scale was used to assess the quality of included studies. RESULTS: Fifty-four studies of cohort, cross-sectional and clinical trial designs were included. Twelve studies assessed PsA flare rates, 28 assessed risk factors and 44 defined flare. The prevalence of current flare ranged between 7% and 50% (n = 8), while the incidence ranged between 10% and 27% over 6 months (n = 3), and 22% and 23% over 12 months (n = 2). Based on high-quality scoring, the current patient-reported flare was 10% (n = 1), while current physician-reported flare was 7% with 22-23% incidence rate over 12 months (n = 2). Criteria used in flare definition could be grouped into seven categories, with disease activity scores (36%), patient-reported (39%) and physician-reported (30%) flare and change in therapy (25%) being frequently used. Risk factors could be grouped into four categories: arthritis therapies, SARS-CoV, PsA features and other. The factors showed limited or unclear evidence. CONCLUSION: The current prevalence of flare ranged between 7% and 10%, and the annual incidence was 22-23%, based on high-quality scoring. Forty-four studies defined flare, revealing no consensus on a single flare definition, and highlighting the need for a standardized definition. No conclusions could be drawn on risk factors, highlighting the need for further research. PROSPERO REGISTRATION: CRD42024482657.
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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 | 0.008 | 0.035 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.008 |
| Bibliometrics | 0.019 | 0.017 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
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".