DAS28 and Rheumatoid Arthritis: The Need for Standardization

Abstract

Disease Activity Score in 28 Joints (DAS28) scoring in rheumatoid arthritis (RA) is now recommended as a basis for clinical decisions about treatment initiation and alteration. The British Society of Rheumatology suggests that most RA patients should have a DAS28 assessment at every clinic visit, to monitor disease activity and the impact of therapy. Establishing an accurate baseline assessment of DAS28, with regular re-evaluation, is considered crucial, so that progress towards a defined target of remission (or low disease activity) can be measured. The Treat-to-Target initiative, launched in March 2010, is now impacting on clinical practice throughout the UK and Europe. One of its key recommendations is that patients should be regularly monitored using validated composite measures of disease activity that include joint assessments. DAS28 is recommended as one of the most useful of these methods but, although it is becoming more widely adopted and training is ongoing, supported by materials produced by the European League Against Rheumatism (EULAR), the variability inherent in the four components of DAS28 means that standardization of practice methods is now an important issue. This short report details some of the pitfalls that can occur when applying DAS28 in clinical practice and suggests some workable solutions to enable departments to set up their own standard operating procedure.

Prostaglandin D2metabolites as a biomarker ofin vivomast cell activation in systemic mastocytosis and rheumatoid arthritis

“…Nearly half ( n = 26) of the patients with RA had moderate disease activity (CRP‐DAS28 = 3.2–5.1) and 22 were in remission (CRP‐DAS28 < 2.59). Of the remaining 12 patients with RA, 3 had high and 9 had mild disease activity, respectively . Most patients with RA were being actively treated with synthetic or biological disease modifying anti‐rheumatic drugs (DMARDs), most commonly combinations of methotrexate and/or leflunomide with an anti‐TNF agent, anti‐IL‐6‐receptor blocker, or other biological DMARD.…”

“…Patients with RA were clinically assessed for the number of tender or swollen joints at the time of specimen collection to determine their Disease Activity Score in 28 joints (DAS28) and the results of serum levels of C‐reactive protein (CRP) taken as part of routine assessment at the time of review recorded. Combined with a patient global assessment of activity, a CRP‐DAS28 score was calculated for each patient as described .…”

Use of the painDETECT tool in rheumatoid arthritis suggests neuropathic and sensitization components in pain reporting

“…Values of DAS28 >5.1 indicate high disease activity, 3.2–5.1 means moderate disease activity, 2.6–3.2 means low disease activity, and a score of <2.6 means the patient is in remission. 21 …”

Sterno Clavicular Joint Osteoarthritis in a Patient With Rheumatoid Arthritis

“…In RA, DAS28 scoring is recommended as a basis for decisions regarding treatment initiation and alteration. 3 Physical examination at the present visit showed hard, non-tender swelling over the right sternoclavicular joint with a mild limitation of right shoulder shrugging in comparison to the left. Rheumatoid arthritis disease activity was low at this time (2.8 on the DAS28 scale).…”

“…Sonography of the right sternoclavicular joint showed reduction of the joint space and irregularity of the medial end of the clavicle ( Figure 1) along with osteophyte formation (Figure 2). No hypervascularity of the right SCJ was noted by color Journal of Diagnostic Medical Sonography 31 (3) or spectral Doppler. Color Doppler imaging of the wrist did show a mild degree synovial hypervascularity (Figure 3).…”