DAS28 score vs. ultrasound examination for assessment of rheumatoid arthritis disease activity: comparison and discussion of pros and cons

Abstract

Rheumatoid arthritis (RA) is a chronic systemic connective tissue disease which is characterized by symetrical multiple joints involvement and extra-articular symptoms. Current EULAR diagnostic criteria for RA include disease activity parameters, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), which are used to calculate disease activity scores, including DAS and DAS28. Recently attempts have been made to assess disease activity using imaging diagnostic modalities, such as magnetic resonance imaging (MRI) and ultrasonography (US). Due to significant progress in therapy effectiveness and early RA diagnosis possibility, imaging modalities become increasingly meaningful and many clinical trials confirm their usefulness. However, there are no consistent criteria for objective assessment of therapy effectiveness based on US. Moreover, it is not US availability that limits its common use, but rather significant variability between operators. This is why US remains only an additional tool to assess therapy efficacy with regard to DAS/DAS28 index.

Cross‐Sectional Evaluation of Periodontal Status and Microbiologic and Rheumatoid Parameters in a Large Cohort of Patients With Rheumatoid Arthritis

“…Health data of participants were obtained from health/medical records of the rheumatology clinic. The following aspects were recorded: 1) age; 2) sex; 3) general illnesses; 4) general medication; 5) lifestyle habits (e.g., smoking habits [smoker or not; definition of non‐smoker: never smoking or non‐smoker for more than the past year]); 6) disease duration (date when the disease started); and 7) details of RA medication, severity, and DAS28 24 . Additionally, current blood parameters of the patients, including levels of aCCP and rheumatic factor (RF), were documented.…”

“…3) general illnesses; 4) general medication; 5) lifestyle habits (e.g., smoking habits [smoker or not; definition of non-smoker: never smoking or nonsmoker for more than the past year]); 6) disease duration (date when the disease started); and 7) details of RA medication, severity, and DAS28. 24 Additionally, current blood parameters of the patients, including levels of aCCP and rheumatic factor (RF), were documented. RF and aCCP were measured from serum samples using commercially available kits i ¶ according to the instructions of the manufacturer.…”

Disease activity, morning stiffness and missing teeth are associated with oral health-related quality of life in individuals with rheumatoid arthritis

“…From the general health records in the rheumatology clinic, the age, sex, smoking habits (smoker or not), disease duration (time since first RA diagnosis), current disease activity score for RA (DAS28-ESR) [19], the presence of swollen or painful joints and morning stiffness of the participants were assessed.…”

Mir-146a and Tlr4 Gene Expression in Predicting Rheumatoid Arthritis Disease

“…One of these limitations is the great weight of the count of swollen joints in the score, as this parameter may not be precisely determined by physical examination provided by a health-care provider. Furthermore, the DAS28 may remain increasedbecause of irreversible damage of joints, which remain tender in spite of subsidence of the inflammatory process (Barczyńska et al, 2015). In addition, ankles and feet joints are not included in the DAS28, which may result in misclassification regarding low disease activity or remission.…”

“…Although, there is no real "gold standard" available to judge RA disease activity (Farnsen et al, 2003), the most commonly used method for evaluation of RA activity is the Disease Activity Score DAS28 because ofthe relative ease of its acquisition and calculation. The formulas of DAS28 calculation incorporate the number of swollen and tender joints, self-health assessment by using the visual-analog scale (VAS), and erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) (Barczyńska et al, 2015). The DAS28 may not provide accurate reflection of disease activity because ofmultiple limitations.…”