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Simplified versions of the original disease activity score: validation in the BeSt trial
  1. R Koevoets1,
  2. NB Klarenbeek1,
  3. M Güler-Yüksel1,
  4. M van Oosterhout2,
  5. MV van Krugten3,
  6. PJSM Kerstens4,
  7. TWJ Huizinga1,
  8. BAC Dijkmans4,5,
  9. DMFM van der Heijde1,
  10. CF Allaart1
  1. 1Leiden University Medical Centre, Leiden, The Netherlands
  2. 2Groene Hart Ziekenhuis, Gouda, The Netherlands
  3. 3Admiraal de Ruyter Ziekenhuis, Vlissingen, The Netherlands
  4. 4Jan van Breemen Research Instituut, Amsterdam, The Netherlands
  5. 5VU Medical Centre, Amsterdam, The Netherlands
  1. Correspondence to Rosanne Koevoets, Department of Rheumatology, Leiden University Medical Centre, Postbus 9600, 2300 RC Leiden, The Netherlands; r.koevoets{at}


Objective To evaluate three disease activity score (DAS) alternatives without the Ritchie articular index (RAI). To compare the use of patient global assessment (PGA) of disease activity versus global assessment of health (GH) in DAS, DAS alternatives and DAS28.

Methods Data from the BeSt study were used, a treatment strategy trial in early rheumatoid arthritis patients aiming at a DAS ≤2.4. DAS alternatives were DAS 0–1, with the RAI (0–3) reduced to a no–yes (0–1) score, DAS tender joint count 53 (DAS TJC53), with a 0–1 TJC in 53 separate joints and DAS TJC44 in 44 joints. Correlation patterns, mean difference from original DAS, classification differences in disease activity level and patient percentages with radiological damage progression per level were determined for all scores.

Results In the majority of patients the scores were equal and correlation was high. Mean difference with the DAS at year 1 was −0.03 for DAS 0–1, 0.18 for DAS TJC53 and 0.11 for DAS TJC44. Classification agreement between scores was high (κ year 1 0.76–0.98). Patient percentages with joint damage progression were similar for all scores. DAS, DAS alternative and DAS28 perform similarly using either PGA or GH.

Conclusion DAS without the RAI perform comparably to the original DAS and may be chosen as alternatives. PGA can replace GH in the DAS, the alternatives and DAS28.

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  • Funding This study was funded by a grant from the Dutch College of Health Insurances (College Voor Zorgverzekeringen) with additional funding provided by Schering-Plough, B V and Centocor. The authors, not the sponsors, were responsible for the study design, the collection, analyses and interpretation of all data, the writing of this article and the decision to publish.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of all the participating hospitals.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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