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A case-study in the clinical epidemiology of psoriatic arthritis: multistate models and causal arguments.

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O'Keeffe, Aidan G 
Tom, Brian DM 
Farewell, Vernon T 


In psoriatic arthritis, permanent joint damage characterizes disease progression and represents a major debilitating aspect of the disease. Understanding the process of joint damage will assist in the treatment and disease management of patients. Multistate models provide a means to examine patterns of disease, such as symmetric joint damage. Additionally, the link between damage and the dynamic course of disease activity (represented by joint swelling and stress pain) at both the individual joint level and otherwise can be represented within a correlated multistate model framework. Correlation is reflected through the use of random effects for progressive models and robust variance estimation for non-progressive models. Such analyses, undertaken with data from a large psoriatic arthritis cohort, are discussed and the extent to which they permit causal reasoning is considered. For this, emphasis is given to the use of the Bradford Hill criteria for causation in observational studies and the concept of local (in)dependence to capture the dynamic nature of the relationships.



Bradford Hill criteria, Causality, Composable Markov process, Damage, Disease activity, Dynamic modelling, Granger causality and non-causality, Interval censoring, Local dependence and independence, Multistate models, Psoriatic arthritis, Random effect, Robust information sandwich estimator, Temporality

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J R Stat Soc Ser C Appl Stat

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Oxford University Press (OUP)