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Disease Activity Score 28 (DAS28) using CRP underestimates the disease activity and overestimates the EULAR response criteria compared with DAS28 using ESR in a large observational cohort of rheumatoid arthritis patients in Japan
  1. Toshihiro Matsui (t-matsui{at}sagamihara-hosp.gr.jp)
  1. Department of Rheumatology, Sagamihara National Hospital, National Hospital Organization (NHO), Japan
    1. Yoshiaki Kuga (kugayoshiaki{at}yahoo.co.jp)
    1. Division of Rheumatic Diseases, Tokyo Metropolitan Bokutoh Hospital, Japan
      1. Atsushi Kaneko (a-kaneko{at}sf.starcat.ne.jp)
      1. Department of Orthopedics, Nagoya Medical Center, NHO, Japan
        1. Jinju Nishino (west{at}kitanet.ne.jp)
        1. Nishino Orthopedics Clinic, Japan
          1. Yoshito Eto (etoy{at}nnh.hosp.go.jp)
          1. Department of Orthopedics, Nagoya Medical Center, NHO, Japan
            1. Noriyuki Chiba (jikko{at}morioka.hosp.go.jp)
            1. Department of Rheumatology, Morioka National Hospital, NHO, Japan
              1. Masayuki Yasuda (yasudamk{at}beppu.hosp.go.jp)
              1. Department of Rheumatology, Beppu Medical Center, NHO, Japan
                1. Koichiro Saisho (saisyo{at}miyakonojo.hosp.go.jp)
                1. Department of Rheumatology, Miyakonojo Hospital, NHO, Japan
                  1. Kota Shimada (k-shimada{at}sagamihara-hosp.gr.jp)
                  1. Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, NHO, Japan
                    1. Shigeto Tohma (s-touma{at}sagamihara-hosp.gr.jp)
                    1. Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, NHO, Japan

                      Abstract

                      Objectives:To compare the disease activity and the improvement of disease activity evaluated between by Disease Activity Score 28 using ESR (DAS28-ESR) and by DAS28 using CRP (DAS28-CRP) in Japanese patients with rheumatoid arthritis (RA).

                      Methods: Data from 3073 RA patients registered in the large cohort database (NinJa: National Database of Rheumatic Diseases by iR-net in Japan) of 2003 was used to calculate DAS28-ESR and DAS28-CRP and disease activities were evaluated. Furthermore, improvements of disease activities were evaluated according to the European League Against Rheumatism (EULAR) response criteria in 1482 RA patients whose DAS28-ESR and DAS28-CRP could be calculated from data of both 2002 and 2003.

                      Results:The mean value of DAS28-CRP (3.59, SD 1.25) was significantly smaller than that of mean DAS28- ESR (4.31, SD 1.32) (p<0.0001). The number of patients who satisfied the criteria of remission was 297 (9.7%) in DAS28-ESR vs 705 (22.9%) in DAS28-CRP and the number of patients with high disease activity was 842 (27.4%) vs 357 (11.6%) for DAS28-ESR and DAS28-CRP, respectively; there was a significant difference between the two (p<0.0001). Change of respective DAS28 was significantly correlated (ΔDAS28-ESR: -0.05, SD 1.14 vs ΔDAS28-CRP: -0.10, SD 1.10) (p< 0.0001); however, the number of 'good response' patients was significantly different (p<0.03) between DAS28-ESR (97 patients, 6.5%) and DAS28-CRP (136 patients, 9.2%).

                      Conclusions:DAS28-CRP significantly underestimated the disease activity and overestimated the improvement of disease activity compared with DAS28- ESR. DAS28-CRP should be evaluated using different criteria from that for DAS28-ESR.

                      • DAS28
                      • DAS28-CRP
                      • ESR
                      • The EULAR response criteria
                      • rheumatoid arthritis

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