The composite DAS Score is impractical to use in daily practice: evidence that physicians use the objective component of the DAS in decision making.
BACKGROUND
The disease activity score for 28 joints (DAS28) is widely used for assessing disease activity in rheumatoid arthritis and its use is recommended for establishing the need for anti- tumor necrosis factor drugs, according to British Society for Rheumatology guidelines. However, calculation of the score requires a laboratory measurement of inflammation (either erythrocyte sedimentation rate or C-reactive protein) so that it is not possible to have the actual score when the patient seen in the clinic and, therefore, it is not possible to make immediate treatment decisions based on the DAS28 score.


METHODS
This is an audit of clinic-based treatment decisions, collecting data for the DAS28 on consecutive patients with rheumatoid arthritis. The nonlaboratory elements of the DAS score were completed along with a physician global assessment and any treatment decisions were recorded.


RESULTS
Data on 100 patients were collected. Even when the patients were judged to have active disease by DAS28 treatment switches or increases were not always made. In logistic regression analyses, using treatment increase or switch as the dependent variable, only the swollen joint count was significant.


CONCLUSIONS
There is evidence from this study that the DAS score is limited in daily clinical practice. In this audit of practice treatment, changes seem to be made on objective physician assessments rather than patient recorded assessments.
Lindsay
Karen
K
Department of Rheumatology, St Luke's Hospital, Bradford, West Yorkshire, UK.
Ibrahim
Gamal
G
Sokoll
Katharina
K
Tripathi
Mitesh
M
Melsom
Richard D
RD
Helliwell
Philip S
PS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult
D018501:Antirheumatic Agents