Logo of annrheumdAnnals of the Rheumatic DiseasesVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Ann Rheum Dis. Oct 2005; 64(10): 1410–1413.
Published online Jun 7, 2005. doi:  10.1136/ard.2005.037333
PMCID: PMC1755218

Is DAS28 an appropriate tool to assess remission in rheumatoid arthritis?

Abstract

Objectives: To study which cut off point of DAS28 corresponds to fulfilment of the American Rheumatism Association (ARA) preliminary remission criteria, and clinical remission criteria in patients with rheumatoid arthritis (RA).

Methods: All adult patients diagnosed with RA at Jyväskylä Central Hospital 1997–98 were assessed for remission at 5 years. Remission was defined as (a) ARA remission; (b) clinical remission (defined as no tender or swollen joints and normal erythrocyte sedimentation rate). DAS28 was used to measure disease activity. A receiver operating characteristics curve analysis was performed to calculate a cut off point of DAS28 that best corresponds to the ARA remission criteria and the clinical remission criteria.

Results: 161 patients (mean age 57 years, 107 (66%) female, 98 (61%) with positive rheumatoid factor, and 51 (32%) with erosions) were studied. At 5 years, 19 (12%) patients met the ARA remission criteria, and 55 (34%) met the clinical remission criteria. The cut off value of DAS28 was 2.32 for the ARA remission criteria, and 2.68 for the clinical remission criteria. In patients with DAS28 <2.32, 11/57 (19%) had tender joints, 6/57 (11%) had swollen joints, and 4/57 (7%) had both tender and swollen joints (66 joint count).

Conclusion: In this study the DAS28 cut off point for the ARA remission was lower than in previous studies. The cut off point for DAS28 remission remains controversial. A substantial proportion of patients below the DAS28 cut off point for remission have tender or swollen joints, or both. DAS28 may not be an appropriate tool for assessment of remission in RA.

Full Text

The Full Text of this article is available as a PDF (76K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Pinals RS, Masi AT, Larsen RA. Preliminary criteria for clinical remission in rheumatoid arthritis. Arthritis Rheum. 1981 Oct;24(10):1308–1315. [PubMed]
  • Harrison B, Symmons D. Early inflammatory polyarthritis: results from the Norfolk Arthritis Register with a review of the literature. II. Outcome at three years. Rheumatology (Oxford) 2000 Sep;39(9):939–949. [PubMed]
  • Quinn Mark A, Green Michael J, Marzo-Ortega Helena, Proudman Susanna, Karim Zunaid, Wakefield Richard J, Conaghan Philip G, Emery Paul. Prognostic factors in a large cohort of patients with early undifferentiated inflammatory arthritis after application of a structured management protocol. Arthritis Rheum. 2003 Nov;48(11):3039–3045. [PubMed]
  • Nissilä M, Isomäki H, Kaarela K, Kiviniemi P, Martio J, Sarna S. Prognosis of inflammatory joint diseases. A three-year follow-up study. Scand J Rheumatol. 1983;12(1):33–38. [PubMed]
  • Harrison BJ, Symmons DP, Brennan P, Barrett EM, Silman AJ. Natural remission in inflammatory polyarthritis: issues of definition and prediction. Br J Rheumatol. 1996 Nov;35(11):1096–1100. [PubMed]
  • Wolfe F, Ross K, Hawley DJ, Roberts FK, Cathey MA. The prognosis of rheumatoid arthritis and undifferentiated polyarthritis syndrome in the clinic: a study of 1141 patients. J Rheumatol. 1993 Dec;20(12):2005–2009. [PubMed]
  • Eberhardt K, Fex E. Clinical course and remission rate in patients with early rheumatoid arthritis: relationship to outcome after 5 years. Br J Rheumatol. 1998 Dec;37(12):1324–1329. [PubMed]
  • Pease CT, Bhakta BB, Devlin J, Emery P. Does the age of onset of rheumatoid arthritis influence phenotype?: a prospective study of outcome and prognostic factors. Rheumatology (Oxford) 1999 Mar;38(3):228–234. [PubMed]
  • van der Heijde DM, van 't Hof MA, van Riel PL, Theunisse LA, Lubberts EW, van Leeuwen MA, van Rijswijk MH, van de Putte LB. Judging disease activity in clinical practice in rheumatoid arthritis: first step in the development of a disease activity score. Ann Rheum Dis. 1990 Nov;49(11):916–920. [PMC free article] [PubMed]
  • Fuchs HA. The use of the disease activity score in the analysis of clinical trials in rheumatoid arthritis. J Rheumatol. 1993 Nov;20(11):1863–1866. [PubMed]
  • van der Heijde DM, van 't Hof M, van Riel PL, van de Putte LB. Development of a disease activity score based on judgment in clinical practice by rheumatologists. J Rheumatol. 1993 Mar;20(3):579–581. [PubMed]
  • Prevoo ML, van Gestel AM, van T Hof MA, van Rijswijk MH, van de Putte LB, van Riel PL. Remission in a prospective study of patients with rheumatoid arthritis. American Rheumatism Association preliminary remission criteria in relation to the disease activity score. Br J Rheumatol. 1996 Nov;35(11):1101–1105. [PubMed]
  • van Riel PL, van Gestel AM. Clinical outcome measures in rheumatoid arthritis. Ann Rheum Dis. 2000 Nov;59 (Suppl 1):i28–i31. [PMC free article] [PubMed]
  • Balsa Alejandro, Carmona Loreto, González-Alvaro Isidoro, Belmonte Miguel Angel, Tena Xavier, Sanmartí Raimon. Value of Disease Activity Score 28 (DAS28) and DAS28-3 compared to American College of Rheumatology-defined remission in rheumatoid arthritis. J Rheumatol. 2004 Jan;31(1):40–46. [PubMed]
  • Fransen J, Creemers MCW, Van Riel PLCM. Remission in rheumatoid arthritis: agreement of the disease activity score (DAS28) with the ARA preliminary remission criteria. Rheumatology (Oxford) 2004 Oct;43(10):1252–1255. [PubMed]
  • Svensson B, Schaufelberger C, Teleman A, Theander J. Remission and response to early treatment of RA assessed by the Disease Activity Score. BARFOT study group. Better Anti-rheumatic Farmacotherapy. Rheumatology (Oxford) 2000 Sep;39(9):1031–1036. [PubMed]
  • Svensson B, Ahlmén M, Forslind K. Treatment of early RA in clinical practice: a comparative study of two different DMARD/corticosteroid options. Clin Exp Rheumatol. 2003 May-Jun;21(3):327–332. [PubMed]
  • van der Heijde DM, Jacobs JW. The original "DAS" and the "DAS28" are not interchangeable: comment on the articles by Prevoo et al. Arthritis Rheum. 1998 May;41(5):942–945. [PubMed]
  • Felson DT, Anderson JJ, Boers M, Bombardier C, Chernoff M, Fried B, Furst D, Goldsmith C, Kieszak S, Lightfoot R, et al. The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. The Committee on Outcome Measures in Rheumatoid Arthritis Clinical Trials. Arthritis Rheum. 1993 Jun;36(6):729–740. [PubMed]
  • Sokka Tuulikki, Pincus Theodore. Most patients receiving routine care for rheumatoid arthritis in 2001 did not meet inclusion criteria for most recent clinical trials or american college of rheumatology criteria for remission. J Rheumatol. 2003 Jun;30(6):1138–1146. [PubMed]
  • Paulus Howard E. Defining remission in rheumatoid arthritis: what is it? Does it matter? J Rheumatol. 2004 Jan;31(1):1–4. [PubMed]
  • Mäkinen Heidi, Kautiainen Hannu, Hannonen Pekka, Sokka Tuulikki. Frequency of remissions in early rheumatoid arthritis defined by 3 sets of criteria. a 5-year followup study. J Rheumatol. 2005 May;32(5):796–800. [PubMed]
  • Jäntti J, Kaarela K, Kautiainen H, Isomäki H, Aho K. Radiographic remission in seropositive rheumatoid arthritis. A 20-year follow-up study. Clin Exp Rheumatol. 2001 Sep-Oct;19(5):573–576. [PubMed]

Figures and Tables

Figure 1
 ROC curves of DAS28 when used to define the presence or absence of the ARA remission criteria and the clinical remission criteria.

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

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

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

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...