[Differential diagnosis of rheumatoid arthritis pain: the role of subjective DAS28 scores, joint ultrasound, and digital biomarkers in therapeutic decision-making].

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The purpose of this review is to examine the diagnostic challenges arising from the mathematical biases of the DAS28 index used in monitoring rheumatoid arthritis, as well as the psychological and neurobiological factors underlying patient-physician discordance. Furthermore, this paper aims to analyze the role of digital biomarkers in future decision-making. A structural characteristic of the DAS28 index is that its subjective components carry twice the weight of objective metrics. In cases of central sensitization, depression, or anxiety, this can result in "false-positive" disease activity, leading to unjustified and costly interventions, as well as ineffective therapy. Literature confirms that patient-physician discordance is one of the primary predictors of therapeutic failure, particularly in difficult-to-treat (D2T) cases. The application of the DAS28-P index can help identify pain-dominant phenotypes. Besides musculoskeletal ultrasound, new technologies, such as keystroke dynamics analysis or artificial intelligence-based imaging, offer objective measures to eliminate subjective biases. Modern rheumatological approaches should integrate psychological support, patient education, and pain modulation alongside immunosuppressive treatment. The implementation of digital biomarkers and hybrid care models not only improves the patient's quality of life but also generates significant system-level cost savings in healthcare. Orv Hetil. 2026; 167(44): 1764-1771.

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