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Is there a need for new thresholds to define remission and low disease activity by Disease Activity Score 28 calculated with C reactive protein? Real life data from a local registry
  1. Ennio Giulio Favalli1,
  2. Andrea Becciolini2,
  3. Martina Biggioggero2,
  4. Antonio Marchesoni1,
  5. Pier Luigi Meroni2
  1. 1Department of Rheumatology, Gaetano Pini Institute, Milan, Italy
  2. 2Department of Clinical Sciences and Community Health, Division of Rheumatology, University of Milan, Gaetano Pini Institute, Milan, Italy
  1. Correspondence to Dr Ennio Giulio Favalli, Department of Rheumatology, Gaetano Pini Institute, Milan 20122, Italy; ennio.favalli{at}

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We read with great interest the recent article by Fleischmann et al which reports a post hoc analysis of five rheumatoid arthritis (RA) randomised clinical trials (RCTs) to evaluate the correlation between Disease Activity Score in 28 joints calculated by using erythrocyte sedimentation rate (DAS28-ESR) or C reactive protein (DAS28-CRP).1 Since its introduction,2 DAS28-CRP has been used to evaluate clinical response in RCTs and daily practice by applying the same DAS28-ESR thresholds to define remission and low disease activity (LDA). Consistently with some previous reports,3–5 Fleischmann et al demonstrated that DAS28-CRP underestimates disease activity when using the same remission and LDA cut-off points validated for DAS28-ESR (2.6 and 3.2, respectively).6 Based on these findings, the authors suggested new thresholds for DAS28-CRP (2.4 for remission and 2.9 …

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