(Vienna, 19 October 2026) Joint damage is a major consequence of rheumatoid arthritis (RA) and can lead to irreversible loss of physical function. While conventional X-rays remain the routine method for assessing structural damage, an international research team led by Peter Mandl from the Division of Rheumatology at the Medical University of Vienna has developed a new ultrasound-based scoring system designed to capture several key aspects of joint damage in a single measure. The Global OMERACT Ultrasound Joint Damage Scoring System (GLODS) combines the assessment of bone erosions, cartilage damage and joint malalignment and showed good to excellent reliability in this first study aiming to establish a consensual global score. The results have recently been published in the "Annals of Rheumatic Diseases".
The study was conducted within the OMERACT Ultrasound Working Group and brought together a group of 25 ultrasound experts from 13 countries. Through a multi-step process combining expert consensus, web-based exercises and examinations of patients with RA, the researchers developed standardized definitions and scoring systems for structural joint damage and tested how consistently these could be applied by different investigators.
Looking beyond inflammation
Ultrasound has become an important, patient-friendly tool for detecting and monitoring inflammation in rheumatoid arthritis. Its potential for assessing the structural damage that accumulates as the disease progresses, however, has been less standardized. Unlike conventional radiography, ultrasound can provide high-resolution, multiplanar images of joint structures without exposure to ionizing radiation and can be repeated over short intervals.
"Structural damage in rheumatoid arthritis is not limited to a single feature. Bone erosions, cartilage damage and changes in joint alignment all represent different aspects of the damage caused by the disease," explains Peter Mandl, first and corresponding author of the study. "Our aim was therefore to bring these components together in a standardized ultrasound score that can be applied reliably."
Three components combined into one score
GLODS assesses three components of structural joint damage: bone erosion on a scale from 0 to 3, cartilage change from 0 to 2, and joint malalignment from 0 to 2. Adding these components produces a global score ranging from 0 to 7 for each joint. The definitions and scoring systems were established through an international Delphi consensus process and subsequently tested in web-based and live patient exercises.
The individual components demonstrated good to excellent reliability. In the live exercise, the combined GLODS showed excellent intraobserver reliability, meaning that individual investigators produced highly consistent results when repeating the assessment, and good interobserver reliability between different investigators. The ultrasound findings also correlated significantly with corresponding measures of structural damage on conventional radiographs.
"These results provide an important methodological foundation for using ultrasound to assess structural joint damage in a standardized way," says Mandl. "The next step will be to investigate how well GLODS captures changes in joint damage over time and to validate the score in independent patient cohorts and clinical trials. "
Towards more sensitive monitoring of structural damage
The new score could ultimately complement established imaging approaches in rheumatoid arthritis research, particularly where repeated assessment of structural damage is needed. However, the authors emphasize that the current study focused primarily on standardization and reliability. Further studies are required to determine the score’s sensitivity to change, longitudinal validity and performance in different joints and patient populations before its broader clinical application can be established.
Publication: Annals of the Rheumatic Diseases
A global OMERACT ultrasound joint damage scoring system (GLODS) in rheumatoid arthritis.
Peter Mandl, Irina Gessl, Lyubomyra Kun, Georgios Filippou, Marion Kortekaas, Carlos Pineda, Lene Terslev, Ingrid Møller, Marina Backhaus, David Bong, Edoardo Cipolletta, Paz Collado, Christian Dejaco, Andrea Delle Sedie, Christina Duftner, Hilde Berner Hammer, Annamaria Iagnocco, Zunaid Karim, Helen Keen, Esperanza Naredo, Greta Pellegrino, Wolfgang A. Schmidt, Silvia Sirotti, Marcin Szkudlarek, Giorgio Tamborrini, Priscilla Wong, Emilio Filippucci, Peter V Balint, Maria Antonietta D’Agostino, im Namen der OMERACT Ultrasound Working Group.
https://doi.org/10.1016/j.ard.2026.07.004