LETTER

A potential pitfall in the use of the Disease Activity Score (DAS28) as the main response criterion in treatment guidelines for patients with rheumatoid arthritis

P V Gardiner¹, A L Bell², A J Taggart², G Wright², F Kee³, A Smyth⁴, R McKane⁴, J Lee⁵, M E Rooney², E Whitehead⁶

¹ Altnagelvin Hospital, Londonderry, N Ireland
² Musgrave Park Hospital, Belfast, N Ireland
³ Northern Health and Social Services Board, Antrim, N Ireland
⁴ Ulster Hospital, Dundonald, N Ireland
⁵ Craigavon Hospital, Craigavon, N Ireland
⁶ Antrim Hospital, Antrim, N Ireland

Correspondence to:
Correspondence to:
Dr P V Gardiner
Altnagelvin Hospital, Glenshane Road, Londonderry BT47 1SB, N Ireland UK; pgardiner@alt.n-i.nhs.uk

Accepted 17 July 2004

Keywords: Disease Activity Score; erythrocyte sedimentation rate; rheumatoid arthritis

The first 150 words of the full text of this article appear below.

The Disease Activity Score¹ is widely used to quantify disease activity and gauge response to treatment. A rather complex calculation conceals the relative contribution of each measure to the composite score. The 28 joint version (DAS28) is used in the British Society for Rheumatology guidelines to determine response to anti-tumour necrosis factor (anti-TNF) treatment.² A reduction in DAS28 of 1.2 is considered significant improvement, as is a reduction in DAS28 score to <3.2. These figures are important, as under current guidelines clinicians are advised to discontinue anti-TNF treatment if either of these criteria is not achieved at 3 months.

In the course of reviewing decisions on whether or not to continue anti-TNF therapy, we identified several patients in whom the change in DAS28 score did not correlate with clinical findings. It was also noted that the clinicians relied heavily on the change in DAS28 score to determine if the . . . [Full text of this article]

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