Prediction of Response to Therapies and Flares Based on Ultrasound Findings at Baseline in Psoriatic Arthritis: An Analysis on a Joint Level
Bibliographic record
Abstract
Objectives It is not clear how to interpret when the ultrasound and physical examination do not agree on a joint level. In this study, we aimed to investigate, within PsA patients who are about to start an advanced therapy: a) the likelihood of achieving a good response; b) the risk of experiencing a flare, on a joint level, 3 months post-therapy, based on the baseline ultrasound inflammation. Methods At the ORCHESTRA (Ottawa Rheumatology CompreHEnSive TReatment and Assessment) Clinic, PsA patients starting a new advanced therapy are assessed using a protocolized US scan. Patients are evaluated in the same clinic for 3 months after therapy initiation. For this analysis, all MCP, PIP, DIP, and wrist joints were included; and analysis was performed on a joint level. US findings at baseline were scored for grayscale synovitis, Doppler signals and Global OMERACT-EULAR Synovitis Score (GLOESS) on scale of 0-3; grade ≥2 being considered positive. Physical exam was conducted at baseline and at 3-months, documenting the tenderness and/or swelling. For prediction of response, joints that were tender and/or swollen at baseline were included in the analysis. For prediction of flares, joints that were not tender and/or swollen at baseline were analyzed. Odds ratios were calculated to determine response and flare rates. Results The analysis included 36 PsA patients (61.1% female) with a mean (SD) age of 50 (12.7). At baseline, 17 patients (47.2%) were bionaïve, while 19 (52.8%) patients had failed 1 or more biologic therapies. A total of 1079 joints were analyzed, 333 (30%) being tender, 151 (14%) being swollen, and 365 (34%) being tender and/or swollen at baseline. Symptomatic joints with high inflammation on US at baseline had a lower response rate (less likely to become asymptomatic) at follow-up) than those without (OR range 0.30-0.66) (Table). Asymptomatic joints at baseline were more likely to flare (become symptomatic at follow-up) if their baseline US inflammation was higher (OR range 1.06-4.73). For both outcomes, the swelling had higher associations than the tenderness of the joint (Table). Table: Response and flare rates based on tender and/or swollen joints at baseline, according the initial US-positivity. Conclusion Our study shows 2 critical implications of positive baseline US findings on a joint level: a) Tender and/or swollen joints with positive US findings are more resistant to therapies compared to those without, and b) non-tender and/or non-swollen joints with positive US findings have a higher risk of developing symptoms. Although the integration of US findings into treatment algorithms is uncertain, they indicate the presence of a distinct patient phenotype.
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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 | 0.004 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".