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• DAS28-CRP should be evaluated using different criteria from that for DAS28-ESR
  José M. Martín Santos
  Published on: 2 April 2007

• Published on: 2 April 2007

  DAS28-CRP should be evaluated using different criteria from that for DAS28-ESR

  • José M. Martín Santos, MD, PhD
  • Other Contributors:
    • Amelia García Chillón, Luis M. Altuzarra Corral

  Dear Editor,

  We have read with interest the article recently published by Matsui et al (1). They study a large cohort of patients with rheumatoid arthritisfrom 33 hospitals in Japan and conclude that the modified Disease Activity Score including 28-joint count and using C-reactive protein (DAS28-CRP) gives mean values lower than the same index using ESR (DAS28-ESR). They find a mean difference of 0.72 and state that DAS...

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  Dear Editor,

  We have read with interest the article recently published by Matsui et al (1). They study a large cohort of patients with rheumatoid arthritisfrom 33 hospitals in Japan and conclude that the modified Disease Activity Score including 28-joint count and using C-reactive protein (DAS28-CRP) gives mean values lower than the same index using ESR (DAS28-ESR). They find a mean difference of 0.72 and state that DAS28-CRP underestimates thedisease activity if the criteria of evaluation for DAS28-ESR are applied.

  The patients included in clinical trials and multicentre studies may be not representative of the usual patients attended in clinical practice. Since 2002 we have registered all the data from all our patients directly into computers using software that calculates different clinical indexes and also enables reports to be given to them when they are still at the office. The analysis of the data from the 266 patients with rheumatoid arthritis treated by one of us in 2006 confirms the same findings reportedby Matsui. In the 242 patients with complete data available, DAS28-CRP waslower than DAS28-ESR (mean difference 0.49). Our results are also similar to those recently published by Inoue, from another large Japanese data base (2). Table I shows the characteristics of our patients and the results of the statistical analysis. It includes a regression line that strongly correlates DAS28-ESR and DAS28-CRP, as well as the proposed cut-off points of DAS28-CRP values that correspond to DAS28-ESR scores of 2'6, 3'2 and 5'1, obtained by means of Receiver Operating Characteristic (ROC) curves and defining remission, low disease activity and high disease activity, respectively. Unlike Matsui, we have not observed larger differences between DAS28-ESR and DAS28-CRP when DAS28 increases. However, the correlation of both indexes is stronger at high values of DAS28, a finding also reported by Inoue.

  Our results support the conclusions of Matsui and Inoue that DAS28-CRP should be evaluated using different criteria from that for DAS28-ESR and extend them to daily practice.

  REFERENCES

  1. Matsui T, Kuga Y, Kaneko A, Nishino J, Eto Y, Chiba N et al. Disease activity score (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. Ann Rheum Dis published online 16 mar 2007.

  2. Inoue E, Yamanaka H, Hara M, Tomatsu T, Kamatani N. Comparison of Disease Activity Score (DAS)28-erythrocyte sedimentation rate and DAS28-C-reactive protein threshold values. Ann Rheum Dis 2007;66:407-409.

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  Conflict of Interest:
  None declared.

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