Development and validation of the manual disease activity score (MDAS) for rheumatoid arthritis

ObjectiveThe inclusion of patient research partners (PRPs) in research projects is increasingly recognised and recommended in rheumatology. The level of involvement of PRPs in translational research in rheumatology remains unknown,...

ObjectiveChronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disease with no validated criteria for assessing disease activity (DA), inactive disease, or remission. To date, DA assessment has relied on subjective judgments from patients, rheumatologists, and/or radiologists. Evaluations based on composite DA measures are emerging. The Pediatric CNO (PedCNO) response score documents relative DA changes during follow‐up in analogy to the Pediatric American College of Rheumatology score for juvenile idiopathic arthritis. The international Childhood Arthritis and Rheumatology Research Alliance (CARRA) CNO initiative proposed a numeric composite DA score (CDAS) on the basis of the patient global assessment of DA (PAG), patient assessment of pain (PAP), and clinically active CNO lesions. We aim to propose different composite scores for assessment of DA, including physician assessment of DA and magnetic resonance imaging (MRI) findings; to evaluate the previously published CNO CDAS and the PedCNO response score using established registry data; and to suggest a PedCNO 90% improvement (PedCNO90) category.MethodsNewly diagnosed patients with CNO were enrolled between 2015 and 2020 and analyzed for clinical course and DA measures (physician global assessment of DA [PGDA]/PAG and pain scores) for up to 4 years of follow‐up (YFU) in the National Pediatric Rheumatologic Database.ResultsA total of 400 patients were enrolled. In single numeric scores only, clinical and MRI lesion scores reached significant changes (from baseline to 3 YFU: P = 0.003/P = 0.004). Composite scores, which include MRI DA scores consisting of one clinical patient‐based assessment parameter (PAG/PAP of DA), the PGDA and MRI lesion count are less dependent on subjective measures and demonstrate more pronounced changes over time of supposed CNO DA compared with the CNO CDAS. A PedCNO90 response score gradually increased during follow‐up, ultimately reaching a PedCNO90 in half of the remaining patients after 4 years.ConclusionComposite scores, including MRI lesions and PGDA, seem to be promising tools for describing the activity of CNO and are proposed. The composition of DA scores seems essential for future studies.

The Sharp-van der Heijde score (SvH) is crucial for assessing joint damage in rheumatoid arthritis (RA) through radiographic images. However, manual scoring is time-consuming and subject to variability. This study proposes a multistage deep learning model to predict the Overall Sharp Score (OSS) from hand X-ray images. The framework involves four stages: image preprocessing, hand segmentation with UNet, joint identification via YOLOv7, and OSS prediction utilizing a custom Vision Transformer (ViT). Evaluation metrics included Intersection over Union (IoU), Mean Absolute Error (MAE), Root Mean Squared Error (RMSE), Huber loss, and Intraclass Correlation Coefficient (ICC). The model was trained using stratified group 3-fold cross-validation on a dataset of 679 patients and tested externally on 291 subjects. The joint identification model achieved 99% accuracy. The ViT model achieved the best OSS prediction for patients with Sharp scores < 50. It achieved a Huber loss of 4.9, an RMSE of 9.73, and an MAE of 5.35, demonstrating a strong correlation with expert scores (ICC = 0.702, P < 0.001). This study is the first to apply a ViT for OSS prediction in RA. It presents an efficient and automated alternative for overall damage assessment. This approach may reduce reliance on manual scoring.

Article The challenges and future perspective for the management of systemic lupus erythematosus in China: A concise annual report of 2020 was published on March 1, 2022 in the journal Rheumatology and Immunology Research (volume 3, issue 1).

Article Hemorrhage or thrombosis? Adrenal involvements in a patient with antiphospholipid syndrome was published on December 1, 2025 in the journal Rheumatology and Immunology Research (volume 6, issue 4).

Article Unusual presentation of a mass and “cobble-stone like” changes in the bronchus of a patient with granulomatosis with polyangitis was published on March 1, 2023 in the journal Rheumatology and Immunology Research (volume 4, issue 1).

Article Vision loss, multiple cerebral infarction, ischemia of extremities: Systemic vasculitis or cardiac myxoma? was published on December 1, 2020 in the journal Rheumatology and Immunology Research (volume 1, issue 1).

Editorial introductions

FRI0067 Changes in Multi-Biomarker Disease Activity (MBDA) Score Correlate with Changes in Established Disease Activity Measurements in Patients with Early Ra from The Opera Study

IntroductionThe aim of this study was to estimate the prevalence and determinants of vitamin D deficiency in patients with rheumatoid arthritis (RA) as compared to healthy controls and to analyze the association between 25-hydroxyvitamin D (25(OH)D) with disease activity and disability.MethodsThe study includes 1,191 consecutive RA patients (85% women) and 1,019 controls, not on vitamin D supplements, from 22 Italian rheumatology centres. Together with parameters of disease activity, functional impairment, and mean sun exposure time, all patients had serum 25(OH)D measured in a centralized laboratory.ResultsA total of 55% of RA patients were not taking vitamin D supplements; the proportion of these with vitamin D deficiency (25(OH)D level <20 ng/ml) was 52%. This proportion was similar to that observed in control subjects (58.7%). One third of supplemented patients were still vitamin D deficient. In non-supplemented RA patients 25(OH)D levels were negatively correlated with the Health Assessment Questionnaire Disability Index, Disease Activity Score (DAS28), and Mobility Activities of daily living score. Significantly lower 25(OH)D values were found in patients not in disease remission or responding poorly to treatment, and with the highest Steinbrocker functional state. Body mass index (BMI) and sun exposure time were good predictors of 25(OH)D values (P < 0.001). The association between disease activity or functional scores and 25(OH)D levels remained statistically significant even after adjusting 25(OH)D levels for both BMI and sun exposure time.ConclusionsIn RA patients vitamin D deficiency is quite common, but similar to that found in control subjects; disease activity and disability scores are inversely related to 25(OH)D levels.

To investigate the effects of early introduction of biologic disease-modifying antirheumatic drugs (bDMARDs) on the disease course in untreated polyarticular juvenile idiopathic arthritis (JIA). We analyzed data on patients with polyarticular JIA participating in the Start Time Optimization of Biologics in Polyarticular JIA (STOP-JIA) study (n = 400) and a comparator cohort (n = 248) from the Childhood Arthritis and Rheumatology Research Alliance Registry. Latent class trajectory modeling (LCTM) was applied to identify subgroups of patients with distinct disease courses based on disease activity (clinical Juvenile Arthritis Disease Activity Score in 10 joints) over 12 months from baseline. In the STOP-JIA study, 198 subjects (49.5%) received bDMARDs within 3 months of baseline assessment. LCTM analyses generated 3 latent classes representing 3 distinct disease trajectories, characterized by slow, moderate, or rapid disease activity improvement over time. Subjects in the rapid improvement trajectory attained inactive disease within 6 months from baseline. Odds of being in the rapid improvement trajectory versus the slow improvement trajectory were 3.6 times as high (95% confidence interval 1.32-10.0; P = 0.013) for those treated with bDMARDs ≤3 months from baseline compared with subjects who started bDMARDs >3 months after baseline, after adjusting for demographic characteristics, clinical attributes, and baseline disease activity. Shorter disease duration at first rheumatology visit approached statistical significance as a predictor of favorable trajectory without bDMARD treatment. Starting bDMARDs within 3 months of baseline assessment is associated with more rapid achievement of inactive disease in subjects with untreated polyarticular JIA. These results demonstrate the utility of trajectory analysis of disease course as a method for determining treatment efficacy.

BackgroundRegular physical activity (PA) highly recommended for patients with inflammatory diseases [1]. It was shown to significantly improve disease activity [1]. However, data regarding the effects of physical activity on...

Background: Rheumatoid arthritis (RA) is an autoimmune disease characterized by systemic inflammation of the joints. Various factors are known to influence the disease activity of RA patients, both sociodemographic and clinical factors. The assessment of RA disease activity using the Disease Activity Score 28 (DAS28) has been widely used. This study aimed to determine the factors associated with RA disease activity based on DAS28 (ESR).Methods: A cross-sectional analytic study was conducted on RA patients aged 18-59 years The samples were grouped into two groups; the DAS28 score group &lt;3.2 (mild disease activity) and DAS28 score &gt; 3.2 (severe disease activity). Factors that influence disease activity in RA patients were taken from secondary data.Results: Patients in the severe disease activity group had a mean age that was older than the mild disease activity group (51.73 ± 12.12 vs 45.67 ± 12.46 years). In the severe disease activity group, higher ESR levels were found (42.00 (3.50-131.00) mm/hour vs 13.50 (0.71-53.40) mm/hour), higher CRP levels. (4.79 (0.30-121.80) mg/dl vs 2.61 (0.05-47.49) mg/dl) and higher pain VAS. The variables found to be associated with RA disease activity were age (p = 0.019), ESR level (p &lt; 0.001), CRP (p = 0.022), and pain VAS (p &lt; 0.001).Conclusion: DAS28 is a commonly used method to assess the severity of RA disease activity. Factors related to disease activity in RA patients based on DAS28 (ESR) were age, level of ESR, pain VAS and CRP.

OP0233-HPR The Feasibility of the Use of Patient-Derived Joint Counts in Treat-to-Target Strategies in Rheumatoid Arthritis

THU0197 Conventional Dmard Therapy and Improvement of Disease Activity in A Cohort of Rheumatoid Arthritis Patients Treated under Treat To Target Recommendations