Disease Activity Score-28 for Rheumatoid Arthritis with ESR (DAS28-ESR)

Why Use

Recently a “treat to target” approach has been recommended: that a DAS score be calculated at frequent intervals while therapies are being given, until a patient’s score suggests disease remission, or to a particular ESR or CRP level.

When to Use

Patients with confirmed rheumatoid arthritis.

Formula

Pearls / Pitfalls

The DAS Scores indicate how active a patient’s rheumatoid arthritis (RA) is currently, and can be trended over time. They were initially developed for comparing clinical trial results of RA drugs, but are now used as overall markers of disease activity. Recently a “treat to target” approach has been recommended: that a DAS score be frequently calculated until a patient’s score suggests disease remission, or to a particular ESR or CRP level. The DAS scores were simplified, previously using 44 joints for assessment, and now instead use 28. Points to keep in mind: There is some degree of inter-rater variability in assessing the DAS scores, as different raters may classify a joint as swollen or tender to different degrees. The feet are not assessed in the DAS28 scores, since foot joint pains may be unrelated to RA activity (since we walk on our feet). Foot assessment, however, should still be considered in the patient’s broader gestalt, and foot complaints should obviously be considered and managed appropriately in RA patients.

Management

The EULAR Response Criteria allows clinicians to categorize the effectiveness of a particular therapy. Please see the table below: Improvement in DAS28 score >1.2 0.6–1.2 ≤0.6 Current DAS28 score ≤3.2 Good Moderate None 3.2–5.1 Moderate Moderate None >5.1 Moderate None None

More Information

Score interpretation: DAS28 Score Range Disease Severity < 2.6 Remission ≥ 2.6 - < 3.2 Low ≥ 3.2 - ≤ 5.1 Moderate > 5.1 High