Comparison of the DAS28-CRP and DAS28-ESR in patients with rheumatoid arthritis

Şengül, İlker; Akçay-Yalbuzdağ, Şeniz; Ince, Bugra; Goksel-Karatepe, Altinay; Kaya, Taciser

doi:10.1111/1756-185x.12695

Cited by 27 publications

(38 citation statements)

References 17 publications

(71 reference statements)

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“…The DAS-28 is a system developed and validated by the EULAR (European League Against Rheumatism) to measure the progress and improvement of RA, and based on four assessments, which are TEN 28 (number of joints with tenderness upon touching), SW 28 (number of swollen joints), ESR and SA (subjective assessment of disease activity by the patient during the preceding seven days on a scale between 0 and 100). A DAS-28 value of >5.1 corresponds to a high disease activity, 3.2 -5.1 corresponds to a moderate disease activity and <3.2 corresponds to a low disease activity [13]. The calculations of DAS-28 were carried out using the DAS-28 calculator, which is available free online (http://www.das-score.nl).…”

Section: Patientsmentioning

confidence: 99%

Gene Expression of Tumor Necrosis Factor-Alpha in Etanercept-Treated Rheumatoid Arthritis Patients

Mahmood¹,

Al-Kazaz²,

Ad’hiah³

et al. 2017

JBM

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Fifty-one rheumatoid arthritis (RA) patients were enrolled to assess the gene expression of tumor necrosis factor-alpha (TNF-α) by reverse transcription quantitative polymerase chain reaction (qRT-PCR) in etanercept-treated RA patients, with some emphasis on clinical and biological markers of disease. The results revealed that the ∆Ct mean range in total, male and female RA patients and controls was 1.286 ± 1.226 -4.023 ± 0.856 and the differences were not. Laboratory and clinical findings in subgroups of patients also showed no significant variations in the distribution of 2 −∆∆Ct means, with the exception of anti-cyclic citrullinated peptide (ACCP) antibodies. The lowest expression was observed in moderate positive patients (1.566 ± 1.104) compared to low and high positive patients (4.061 ± 1.366 and 9.668 ± 3.518, respectively) for ACCP antibodies, and the difference was significant (p = 0.043). Inspecting the 2 −∆∆Ct means in duration of disease and gender revealed that male patients recorded a lower mean than female patients (0.827 ± 0.550 vs. 4.143 ± 1.317) at <5 years disease duration, while at >10 years duration of disease, female patients showed a lower mean than male patients (1.242 ± 0.372 vs. 5.607 ± 3.334). However, both differences were not significant. It is concluded that etanercept was effective in normalizing the TNF gene expression, but variations that were related to gender, duration of disease and some biological markers of disease, were observed.

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Section: Patientsmentioning

confidence: 99%

Gene Expression of Tumor Necrosis Factor-Alpha in Etanercept-Treated Rheumatoid Arthritis Patients

Mahmood¹,

Al-Kazaz²,

Ad’hiah³

et al. 2017

JBM

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“…In all of these arthritides, inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) can be raised, but it is increasingly recognized that in some cases the joint inflammation is not reflected by a systemic inflammatory response. 15 Extra-articular signs, particularly inflammatory eye symptoms can be present in many patients. 16 We report here four cases of patients who presented to our Rheumatology Department with high titers of anti-CCP and RF but with symptoms that fit a clinical diagnosis of a SpA, including reactive arthritis.…”

Section: Introductionmentioning

confidence: 99%

Strongly positive anti‐CCP antibodies in patients with sacroiliitis or reactive arthritis post‐E. coli infection: A mini case‐series based review

2017

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We report here on four cases of patients with strongly positive anti-citrullinated cyclic peptides (anti-CCP) antibodies and clinical features of seronegative spondyloarthritis (SpA) and reactive arthritis. The four patients had various clinical presentations: one had an initial diagnosis of seropositive rheumatoid arthritis (RA) with involvement of the sacroiliac joints (similar to previous reports of the association of two diseases); one had a clinical picture of reactive arthritis following an episode of an Escherichia coli positive urinary tract infection; and two had asymmetrical sacroiliitis (SII), but no evidence of peripheral joint involvement (never reported before). In all cases, high titers of anti-CCP antibodies were found. We present a comparison of the clinical manifestations, radiographic features and treatment regimens of these cases. Our report supports previous literature data of possible overlap existing between RA and SpA, but also presents for the first time the association of high titers of anti-CCP antibodies with SII and reactive arthritis in patients with no peripheral small joint involvement.

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“…[18] However, results of the present study potentially affect the interpretation of earlier studies’ findings, where there was underestimation of disease activity by DAS28-CRP compared to DAS28-ESR, if the lower reporting limit of <10 mg/L was used by the local laboratory. [19,20] …”

Section: Discussionmentioning

confidence: 99%

No further gain can be achieved by calculating Disease Activity Score in 28 joints with high-sensitivity assay of C-reactive protein because of high intraindividual variability of C-reactive protein

et al. 2017

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Disease Activity Score in 28 joints (DAS28) is commonly used to evaluate disease activity of rheumatoid arthritis (RA) and is a guide to treatment decision.The aim of this study was to evaluate the impact of lower reporting limit for C-reactive protein (CRP), with respect to intraindividual biological variability, on the calculation of DAS28 and subsequent patient classification.This study consists of 2 sections: a theoretical consideration discussing the performance of CRP in calculating DAS28 taking intraindividual biological variation and lower reporting limit for CRP into account and a cross-sectional study of RA patients applying our theoretical results. Therefore, we calculated DAS28 twice, with the actual CRP values and CRP = 9 mg/L, the latter to elucidate the positive effects of reducing the lower reporting limit of CRP from <10 to <3 mg/L.Lower-reporting limit of <10 mg/L leads to overestimate DAS28. However, reducing lower reporting limit for CRP to <3 mg/L results in optimizing DAS28 calculation. Further lowering of reporting limit for CRP to <3 mg/L does not increase the precision of DAS28 owing to the relatively large intraindividual biological variation.Five hundred twelve patients were included. There was a significant difference between recalculated and patients DAS28 (P < 0.001). One hundred nine patients had DAS28 deviation (compatible to remission to low: 66, low to moderate: 39. and moderate to high: 4).Owing to significant impact of intraindividual biologic variation on DAS28 and patient classification, special attention should be paid to calculate DAS28 when CRP values are within normal range. Furthermore, we conclude that results of different studies evaluating DAS28 and treatment response are not comparable if the reporting limits of CRP are unknown.

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Comparison of the DAS28-CRP and DAS28-ESR in patients with rheumatoid arthritis

Cited by 27 publications

References 17 publications

Gene Expression of Tumor Necrosis Factor-Alpha in Etanercept-Treated Rheumatoid Arthritis Patients

Gene Expression of Tumor Necrosis Factor-Alpha in Etanercept-Treated Rheumatoid Arthritis Patients

Strongly positive anti‐CCP antibodies in patients with sacroiliitis or reactive arthritis post‐E. coli infection: A mini case‐series based review

No further gain can be achieved by calculating Disease Activity Score in 28 joints with high-sensitivity assay of C-reactive protein because of high intraindividual variability of C-reactive protein

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