Interview with SPIDeRR partner: Isabel Castrejón

“The fact that a questionnaire-based tool, using only patient-reported symptoms, was able to accurately identify potential fibromyalgia cases was both impressive and encouraging”

During the SPIDeRR conference in Stockholm, we interviewed Isabel Castrejón, Associate Professor at Complutense University of Madrid, and rheumatologist and clinical researcher at Madrid’s Gregorio Marañón University Hospital. At this hospital, as part of work package 3, she focuses on the implementation of rheumatic disease management. “We are actively involved in an early arthritis program in collaboration with primary care physicians, aimed at improving early diagnosis and treatment. With a strong emphasis on the project's goals, I balance my clinical responsibilities, spending three days a week in the clinic, while dedicating additional time to research”, says Castrejón.

Developing a data-driven referral tool
Castrejón explains that work package 3, Modular Diagnostics, aims to develop Rheumatic, a questionnaire that uses data to help patients with joint and muscle problems find the right care and improve their communication with healthcare providers. This tool will be used in several countries, and efforts are being made to translate it into different languages. Moreover, the team of work package 3 is also working on recruiting healthcare sites to participate in the project and focusing on collecting and organizing data to ensure that it is consistent across different databases. This will help validate diagnostic tools, such as Modular-SPIDeRR, which assists doctors in referring patients to specialists for further care.

Optimizing care through patient questionnaires
Recent findings emphasize the importance of using patient feedback though patient-reported outcomes (PROs) to better understand patient needs, especially for conditions like rheumatoid arthritis, osteoarthritis, and fibromyalgia. This can help identify patients who require early evaluation and intensive treatment, while also guiding decisions for those who may benefit from less invasive approaches such as physiotherapy or exercise. Castrejón: “With an aging population and a shortage of specialists, PROs can help improve how healthcare resources are used and ensure that care is more focused on each patient's individual needs, which can make the overall healthcare system more efficient.”

Promising results for fibromyalgia screening
Reflecting on some unexpected outcomes within the project over the past year, Castrejón shares that the team was pleasantly surprised by how well the system performed in identifying patients with fibromyalgia — a condition that is often difficult to diagnose, as it typically requires ruling out other possible causes. “While rheumatologists are usually more familiar with fibromyalgia, many other doctors find it challenging to recognize, which can lead to unnecessary tests, delays in care, and frustration for patients. The fact that a questionnaire-based tool, using only patient-reported symptoms, was able to accurately identify potential fibromyalgia cases was both impressive and encouraging. It offers hope for faster diagnosis and better-targeted care for patients who often struggle to get the help they need.”

Collaborating across borders
One of the project’s key challenges — and strengths — is adapting shared tools to fit the diverse healthcare systems involved. Researchers from different countries and disciplines bring varied perspectives and practices, which enrich the work but also require flexibility. Differences in how patients are referred, particularly between primary care and rheumatology, have shown the importance of context-sensitive approaches. Castrejón explains: “For example, while patients in some countries can go directly to a specialist, in Spain they must first go through a primary care doctor. This diversity has led to valuable conversations and mutual learning, especially on how best to work with primary care to ensure proper referrals. Strengthening this connection can reduce unnecessary visits to specialists, improve patient satisfaction, and make healthcare more efficient. It’s also been reassuring to see that many challenges are shared across systems, which reinforces the power of collaboration in finding practical, effective solutions”.

Data integration in clinical practice
After over a decade of research and validation work in patient reported outcome measures it's exciting to see real progress towards implementing a patient questionnaire in clinical practice, notes Castrejón. This approach could change how patients are referred and prioritized by using their own input in a structured way. “In healthcare today, we collect vast amounts of information during evaluations, but much of it remains underutilized. By integrating these data more effectively, we can enhance patient management and decision-making. Medicine is inherently complex, with doctors having to consider many different factors at once — often relying on experience and instinct. But projects like this help us use technology and teamwork to support that process in new and powerful ways.”

Innovate recruitment strategies
Work package 3 currently focuses on improving recruitment processes, using the newly approved Spanish version of Rheumatic. The main target groups include primary care patients, members of the general public who may have symptoms of rheumatic conditions, and individuals already receiving care in rheumatology settings. To reach a broad and diverse audience, Castrejón notes that the work package plans to collaborate with patient associations and make use of its active scientific network, which offers accessible, Spanish-language resources for patients. Alongside traditional outreach through social media, the team is also exploring creative communication strategies — such as advertising on buses — to ensure the study is visible and inclusive.

Improving patient care
As Castrejón explains, it's important for doctors to take part in research, so they can turn everyday clinical questions into practical solutions that help improve patient care over time. There’s always room to do better — especially with today’s challenges, like the growing role of artificial intelligence, a shortage of specialists such as rheumatologists, and the pressure to use limited healthcare resources more wisely, especially in public systems. “Research projects like SPIDeRR offer a valuable approach to optimizing resource allocation and ensuring that investments are directed toward improving patient outcomes, ultimately benefiting both patients and healthcare systems.”

Collaborative spirit
Working with the SPIDeRR team is an incredible experience for Castrejón, who adds it’s an honour to collaborate with such a talented group of individuals. “The friendly, supportive environment fosters open sharing of data and ideas, creating the ideal atmosphere for scientific progress. This collaborative ambiance exemplifies how science should be done — through continuous learning, regardless of background, and the opportunity to share knowledge. SPIDeRR has not only provided a space for growth as both physicians and researchers, but it has also emphasized the importance of involving patients in the research process. Their input is crucial, as research that is not developed with patients’ needs in mind is difficult to implement effectively in the future.”