Should quantitative assessment of rheumatoid arthritis include measures of joint damage and patient distress, in addition to measures of apparent inflammatory activity?

Elevated DAS28-ESR in patients with rheumatoid arthritis who have comorbid fibromyalgia is associated more with tender joint counts than with patient global assessment or swollen joint counts: implications for assessment of inflammatory activity

“…The data indicate moderate control of inflammatory activity in both groups according to SJC with median levels of 4.0 in FM+ vs. 3.0 in a conservative prevalence of FM+ RA of 20% (15,43), of whom 75% would have DAS28-ESR of at least 3.84, 15% of all RA patients would be classified as in moderate activity even if all had ESR SJC of 0 and ESR of 10 (https:// www.4s-dawn.com/DAS28). DAS28 and other RA indices also may be elevated significantly by comorbidities beyond fibromyalgia, independent of inflammatory activity (44), including comorbid depression, estimated to be seen in 9.5% -41.5% of people with RA (10-14) and comorbid hand osteoarthritis (OA), seen in 52% of RA patients (45). Possible elevations of TJC and/or PATGL leading to an elevated DAS28 in the presence of considerable, little, or no inflammatory activity indicates a need for rheumatologists to actively interpret these scores.…”

“…This information, along with other reports in the medical literature, may be relevant to possible further revision of RA remission criteria, treatto-target, and routine clinical patient care. It is feasible in routine care to use a single MDHAQ (multidimensional health assessment questionnaire) to screen for FM according to FAST4 (fibromyalgia assessment screening tool), as well as depression according to MDS2 (MDHAQ depression screen)(44). The findings may be of value to improve monitoring of RA patients in clinical trials, other clinical research, and routine rheumatology care.…”