New Disease Activity Score Offers Hope for Improved APS Treatment and Trials
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A novel tool to measure disease activity in antiphospholipid syndrome (APS) has been developed by the european Alliance of Associations for Rheumatology (EULAR), possibly revolutionizing clinical trials and patient care for this complex autoimmune disorder. The new score,known as EAPSDAS,promises a more precise way to track symptoms over time,differentiating between disease activity and overall severity.
APS, a systemic autoimmune disorder, is characterized by the presence of antiphospholipid antibodies and a wide range of clinical features. These can include blood clots (thrombotic events), complications during pregnancy (obstetric symptoms), and issues affecting small blood vessels (microvascular and non-thrombotic manifestations). The severity of these symptoms can vary greatly between individuals, impacting one or multiple areas of the body. Recent research suggests that both thrombotic and inflammatory processes contribute to the development of APS.
The Need for a Dedicated Activity Score
While EULAR collaborated wiht the American College of Rheumatology in 2023 to establish classification criteria for APS – focusing on five key domains – a dedicated disease activity score was still needed. According to experts, such a score would be invaluable for evaluating a patient’s response to treatment in clinical trials, and also for monitoring disease progression in real-world clinical settings.
Crucially, the concept of disease activity differs from disease severity. Severity encompasses both current activity and accumulated damage, impacting a patient’s health, function, quality of life, and long-term prognosis. Disease activity, conversely, focuses on now current inflammation and clinical manifestations.
“The maximum score gives an indication of the highest or peak level of activity, while the average score provides an indication of the persistence,” explained a senior official involved in the development process.
Implications for Future Treatment and Research
The development of EAPSDAS arrives at a pivotal moment, as new treatment targets and potential therapies for APS are emerging. The new score will facilitate well-designed clinical trials to evaluate these novel treatments. Using EAPSDAS as a primary outcome measure in future trials will allow researchers to assess disease activity status and a patient’s response to therapy across a range of APS manifestations, including thrombotic events, pregnancy-related complications, microvascular issues like APS nephropathy, and non-thrombotic conditions such as thrombocytopenia or heart valve disease.
Initial validation of EAPSDAS has been completed using data-driven and consensus methodology. While further prospective validation studies are warranted, EULAR is optimistic that the new score will become a standard tool for evaluating APS activity in clinical trials and ultimately improve the lives of those living with this challenging condition.
Professor Maria Tektonidou, lead author of the study and Head of the Rheumatology Unit at the National and Kapodistrian University of Athens, Athens, Greece, spearheaded the development of this crucial tool.
Source: European Alliance of Associations for Rheumatology, EULAR
Journal reference: Tektonidou, M. G.,et al.(2025) Development and validation of a EULAR disease activity score in antiphospholipid syndrome. Annals of the Rheumatic Diseases. doi: 10.1016/j.ard.2025.05.281. https://www.sciencedirect.com/science/article/abs/pii/S0003496725013147 .
