Background The evaluation of activity in Rheumatoid arthritis (RA) traditionally depend on the physicians’ evaluation and patients’ impressions. The most commonly used remission criteria of DAS28 includes tender joint count and also patient global assesment. In recent studies, effects of patient-reported components to DAS28 scores were suggested.
Objectives To compare the distribution of patients withfibromyalgia (FM), depression, anxiety and fatigue in remission and low disease activity (LDA) according to DAS28 activity score and to determine the prevalance of patients with FM, depression and anxiety that meet DAS28 and new ACR/EULAR remission (Boolean remission) criteria in RA.
Methods The subjects in this study are RA patients who have been participated in a hospital-based observational cohort since 2002. Patients were in remission with DAS28 and were in LDA according to DAS28 at the last visit before recruitment to the study. The patients with Boolean remission were also determined and the discrepancy in terms of FM, depression and anxiety between DAS28 and Boolean remission was investigated with previously defined assessment criteria. A new version of FM assessment criteria was used in comparison with the previous one. Fatigue of patient and control groups was measured by MAF scale, a self administered questionnaire
Results The study population included 23 healthy controls and 86 RA patients [54 (62,7%) in remission and 32 (37,3%) in LDA group]. The relationship between mean MAF, anxiety and depression scores and also the presence of FM in three main groups were non-significant (NS) (remission, LDA and control groups).
Fourteen patients in remission and 4 patients in LDA according to DAS28 fulfilled remission criteria of Boolean. When patients were divided into remission and non-remission subgroups according to the criteria of Boolean, significant differences were observed for mean MAF (5,36±6,75 vs 17,96±1,26), depression (2,72±3,42 vs 5,09±4,35) and HAQ (0,11±0,19 vs 0,45±0,36) (p<0.05), but not with anxiety scores (NS) between the groups.
Patients in remission according to DAS28 and Boolean criteria were also compared for the difference of depression scores and the presence of FM. Seventeen patients had depression in DAS28 remission group, whereas only 2 had depression with remission based on Boolean criteria (p=0.000). The number of patients with FM based on new and previous criteria in patients with remission according to Boolean and DAS28 was also different (for new citerion 0 vs 5 patients, p=0,01, for previous criterion 0 vs 3 patients, p=0,02)
Conclusions Patients in Boolean remission were less affected with FM and depression than DAS28. FM and depression might be the causes of loss of concordance between DAS28 and Boolean criteria and evaluation of them in patients with DAS28 remission, but not fulfilling Boolean criterion, would be appropriate.
Ton E, Bakker MF, Verstappen SM, et al. Look Beyond the Disease Activity Score of 28 Joints (DAS28): Tender Points Influence the DAS28 in Patients with Rheumatoid Arthritis. J Rheumatol.2012 Jan;39(1):22-27.Epub 2011 Oct 15.
Disclosure of Interest None Declared