Logo of annrheumdAnnals of the Rheumatic DiseasesVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Ann Rheum Dis. 2003 May; 62(5): 419–422.
PMCID: PMC1754526

Applying low disease activity criteria using the DAS28 to assess stability in patients with rheumatoid arthritis


Objectives: To examine whether low disease activity criteria using the disease activity score (DAS28) can be applied to identify a reasonably large number of patients with stable low disease activity of rheumatoid arthritis (RA) over a six month period, with the ultimate intention of including these patients in a substitution based, shared care model. Additionally, to assess the reliability of the DAS28 for selecting patients with stable disease from an outpatient population.

Methods: Patients regularly seen at the rheumatology outpatient department of the university hospital Maastricht, were invited for assessment of the stability of their RA. The shared care model was intended to provide care to patients with stable, low disease activity of RA by nurse specialists. For this, patients underwent assessments using the DAS28 criteria at entry and three and six months later. Test-retest reliability was assessed for composing measures as well as for the DAS28.

Results: Of the 97 outpatients included, one third (31 patients) did not complete the study. Patients with missing data were older and assessed their disease activity as greater than patients with complete data. Applying the low disease activity criteria to assess stability over a period of six months (DAS28(T0)[less-than-or-eq, slant]3.2 and DAS28(T6)-DAS28(T0)[less-than-or-eq, slant]1.2) resulted in identification of 22/56 (39%) patients with stable, low disease activity of RA. A good similarity score (intraclass correlation coefficient=0.82) for the DAS28 was found.

Conclusions: The low disease activity criteria using the DAS28 can be used to select patients with stable, low disease activity of RA from a rheumatic outpatient population.

Full Text

The Full Text of this article is available as a PDF (109K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Jenkins-Clarke S, Carr-Hill R, Dixon P. Teams and seams: skill mix in primary care. J Adv Nurs. 1998 Nov;28(5):1120–1126. [PubMed]
  • Richards A, Carley J, Jenkins-Clarke S, Richards DA. Skill mix between nurses and doctors working in primary care-delegation or allocation: a review of the literature. Int J Nurs Stud. 2000 Jun;37(3):185–197. [PubMed]
  • Vrijhoef HJ, Spreeuwenberg C, Eijkelberg IM, Wolffenbuttel BH, van Merode GG. Adoption of disease management model for diabetes in region of Maastricht. BMJ. 2001 Oct 27;323(7319):983–985. [PMC free article] [PubMed]
  • Davis RM, Wagner EG, Groves T. Advances in managing chronic disease. Research, performance measurement, and quality improvement are key. BMJ. 2000 Feb 26;320(7234):525–526. [PMC free article] [PubMed]
  • van Gestel AM, Prevoo ML, van 't Hof MA, van Rijswijk MH, van de Putte LB, van Riel PL. Development and validation of the European League Against Rheumatism response criteria for rheumatoid arthritis. Comparison with the preliminary American College of Rheumatology and the World Health Organization/International League Against Rheumatism Criteria. Arthritis Rheum. 1996 Jan;39(1):34–40. [PubMed]
  • Kirwan JR. A theoretical framework for process, outcome and prognosis in rheumatoid arthritis. J Rheumatol. 1992 Mar;19(3):333–336. [PubMed]
  • Boers M, van Riel PL, Felson DT, Tugwell P. Assessing the activity of rheumatoid arthritis. Baillieres Clin Rheumatol. 1995 May;9(2):305–317. [PubMed]
  • Felson DT, Anderson JJ, Boers M, Bombardier C, Furst D, Goldsmith C, Katz LM, Lightfoot R, Jr, Paulus H, Strand V, et al. American College of Rheumatology. Preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheum. 1995 Jun;38(6):727–735. [PubMed]
  • van Gestel AM, Haagsma CJ, van Riel PL. Validation of rheumatoid arthritis improvement criteria that include simplified joint counts. Arthritis Rheum. 1998 Oct;41(10):1845–1850. [PubMed]
  • Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. [PubMed]
  • Prevoo ML, van Riel PL, van 't Hof MA, van Rijswijk MH, van Leeuwen MA, Kuper HH, van de Putte LB. Validity and reliability of joint indices. A longitudinal study in patients with recent onset rheumatoid arthritis. Br J Rheumatol. 1993 Jul;32(7):589–594. [PubMed]
  • Bravo G, Potvin L. Estimating the reliability of continuous measures with Cronbach's alpha or the intraclass correlation coefficient: toward the integration of two traditions. J Clin Epidemiol. 1991;44(4-5):381–390. [PubMed]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...