During the second reporting period, SPIDeRR made strong progress towards improving stratification of patients with musculoskeletal complaints through secure data integration, digital triage tools, advanced modelling and implementation research. The consortium further established its legal, governance and technical framework for cross-border health-data research, centred on the myDRE trusted research environment and supported by data access agreements, DPIAs and a dedicated data governance framework. Primary- and secondary-care datasets from several European healthcare systems were obtained, structured and harmonised, enabling the first large-scale cross-country analyses of musculoskeletal complaint coding, referral patterns and care trajectories, covering more than 4 million adults in primary care and more than 600,000 patients in secondary rheumatology care. Rheumatic? progressed from model training to external validation and usability testing, with the immune-mediated rheumatic disease model showing strong rule-out performance and additional models retained for fibromyalgia and confirmation of osteoarthritis/fibromyalgia. The tool was further translated and culturally adapted across consortium languages, while validation and recruitment continued in general population, primary-care and rheumatology settings. Modular-SPIDeRR advanced towards operational model implementation through common data model development, a reusable Kedro-based analytical pipeline and refined validation strategies. The Rheumatic Digital Twin framework was finalised and published, with clinically relevant prototypes developed for joint-involvement patterns, referral-letter triage and longitudinal disease trajectories. WP5 progressed genetic and biological risk-factor analyses through harmonisation of genotyping datasets, polygenic risk score modelling and causal modelling of flare-risk data. Implementation work also advanced through completed patient journey studies, five SPIDeRR personas, interactive patient journey maps, and usability, acceptability and feasibility studies of Rheumatic?. Dissemination increased through publications, abstracts, oral presentations, newsletters, tutorials, workshops and patient-facing communication. Overall, SPIDeRR remains on track, with major achievements in secure data governance, harmonised multi-country analyses, validated digital triage tools, reusable AI pipelines, Digital Twin methodology and implementation evidence. The main challenges were ELSA Science AB’s bankruptcy and remaining SERMAS data-sharing restrictions under Spanish ENS requirements, both mitigated through task redistribution, platform continuity measures and local-analysis workflows.
