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    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
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    Patent Pending

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

    Describes severity of rheumatoid arthritis using clinical and laboratory data, specifically CRP.
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    Why Use

    Patients with confirmed rheumatoid arthritis.

    • 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.

    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.

    joints
    joints
    mg/L

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    Evidence
    Creator Insights

    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

    Formula

    DAS28-CRP= (0.56*√(tender joint count) + 0.28*√(swollen joint count) + 0.36*ln(CRP + 1) + 0.014*patient global + 0.96)

    Global health: Ask the patient to rate their current quality of life by making a mark on a visual analog scale:
    Visual Analog Scale

    Facts & Figures

    Score interpretation:

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

    Literature

    Dr. Jaap Fransen

    About the Creator

    Jaap Fransen, MD, is a senior researcher in rheumatology and professor of clinical research at the Radboud University Medical Center Nijmegen, the Netherlands. His research focuses on improving prognostication and treatment for rheumatic diseases including rheumatoid arthritis, psoriatic arthritis, gout and systemic sclerosis.

    To view Dr. Jaap Fransen's publications, visit PubMed