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    Patent Pending

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

    Describes severity of rheumatoid arthritis using clinical and laboratory data, specifically ESR.
    When to Use
    Pearls/Pitfalls
    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
    mm/hr
    0.0 - Very Well
    0
    0.5
    +0.5
    1.0
    +1
    1.5
    +1.5
    2.0
    +2
    2.5
    +2.5
    3.0
    +3
    3.5
    +3.5
    4.0
    +4
    4.5
    +4.5
    5.0
    +5
    5.5
    +5.5
    6.0
    +6
    6.5
    +6.5
    7.0
    +7
    7.5
    +7.5
    8.0
    +8
    8.5
    +8.5
    9.0
    +9
    9.5
    +9.5
    10.0 - Very Poor
    +10

    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Désirée van der Heijde

    About the Creator

    Désirée van der Heijde, MD, is a professor of rheumatology at Leiden University Medical Center, the Netherlands and is affiliated with Diakonhjemmet Hospital in Oslo, Norway. She founded the Assessment in SpondyloArthritis international Society (ASAS) in 1995. Dr. van der Heijde is a principal investigator for clinical trials focused on rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis.

    To view Dr. Désirée van der Heijde's publications, visit PubMed

    Are you Dr. Désirée van der Heijde? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    About the Creator
    Dr. Désirée van der Heijde
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