Hi Julie,

Like you, I`m baffled as to why feet and ankles "don`t count," as I have never been given a proper answer to that. It used to really annoy me, because the first hospital I was at, my ankles & feet were hardly ever examined, if at all. It`s different at my present hospital, which is good, because my feet & ankles are quite badly affected by the RA.

Maybe someone else will know the answer!

Take care,

Kathleen x

There also doesn't seem to be any real help when it comes to ankles and feet yet I find it's the greatest contributing factor in my (lack of) mobility.

I have a secret inclination that it is because we do all nearly have alot of trouble with hands and feet so if they included these an awful lot more of us would
[size=8][/ qualify for the drugs!!

Thanks once again for you replies and thanks for taking the time to look Lyn. Hope all goes well at the hospital.

Julie x

Hi guys, I'm back with the info!

As Barbara points out feet and ankles do take a lot of battering over the years for one reason or another and it is generally accepted that majority of RA patients will have some problems with their feet and this is accepted as being the case before further assesment is undertaken. There is also mention of the fact that feet are less accessible for examination than say hands, although that to me sounds like a bit of a cop out!! My feet, where the RA started, have been extremely problematical requiring a lot of surgery but have to say that current problems are probably more to do with joint damage than ongoing disease.

I previously posted about the Liverpool 'DAS' workshop on the old forum; knew I'd written something of length somewhere! I'll post it again here for any interested parties.I'm not actually sure that this info will help anyone but it might, so posting on that basis!!

Lyn x


I went to the DAS workshop at the BSR conference in Liverpool a few weeks ago. NRAS assisted by providing suitable people to act as 'guinea pigs'. I was one of those lucky people and I am now a whole lot wiser about the overall process for determining disease activity and subsequent drug treatment.

The ESR does provide a vital element in the DAS (Disease Activity Score) and,although no-one may be mentioning it specifically, it is used in the calculations.

The DAS used in rheumatology units is the DAS 28. This involves assessment of 28 joints in the hands (10 each), wrists (1 each), elbows (1 each), shoulders (1 each) and knees (1 each). Each joint is checked for tenderness and swelling and scored on a chart accordingly. There are other DAS methods available, DAS 56 and I think, DAS 78. It was found that the DAS 28 provided very similar results in terms of synovitis in the joints representative of disease activity throughout the body as those used for checking many more joints. Obviously the time involved in checking 78 joints is rather more than 28 and it is now standard practice to use the DAS 28 method.

I, too, often wondered about this as my feet were the first to show significant joint damage and subsequent metatarsal head removal. Due to the damage they are often more painful than other bits. I am assured however that this is due to joint damage and not, for the main part, ongoing disease activity. It was stressed that the feet are most likely to 'feel bad' because they're in constant use. Seems reasonable!

The scoring is done using a special DAS calculator and combines the tender joints, the swollen joints (ie those showing synovitis), the ESR and the VAS and a couple of factors thrown in!

The VAS is a visual analogue scale. It's the chart which shows how you rate your overall well being and how active you feel your arthritis is in the previous week.

Basically it's best to be completely honest on the day you go for assessment. The nurse will be able to tell from the joint check how bad the problems are. If you're having a particularly good day it's always worth mentioning so that if necessary you can be recalled for further investigation when things are bad. At the end of the day you need to receive traetment that is appropriate for your condition otherwise you won't benefit to the maximum. Drugs can always be adjusted, up or down, as necessary but the starting point needs to be right for you.

So Damajo, back to you! I too have low blood counts as I'm sero-negative. I was diagnosed 20 years ago and have been through the full spectrum of drugs. My ESR dithers around 10 and 11, occasionally dropping below 7, but of late it's risen to 20. For me that is high; It has been over 100 but that tends to be during flares.

The doctors should consider you as a whole and not just go off the ESR, which I'm sure will be the case. I'm on my second anti-tnf, first infliximab which my body became accustomed to fairly quickly and now Enbrel +Methotrexate which I have been on for three years successfully. Just had my MTX increased due to increase in ESR and DAS. Our bodies change constantly and it is this continuous process of change that makes RA so difficult to control. There are so many factors to consider it makes drug therapy very difficult. The one thing to remember though is that disease activity is only one factor in determining the correct treatment.

Sorry if I've waffled on but I do hope that this info. will prove useful to someone. These things are rarely explained to it was great to get an inside view.

Hi Julie

It's purely an assessment of how things stand at that point in time which is why it's important when going for an initial assessment that you haven't taken anything that will dampen the inflammation levels as it will give a false DAS score. That said the overall decision for the precribing of anti-TNF drugs will take account of other factors such as joint damage, previous medication, other symptoms such as fatigue etc. They need a baseline of your condition prior to starting so that they can use that in determining the efficacy of the drug on a regular basis (mine is 6 monthly).

Good luck with the assessment Julie. Hope it goes well,

Lyn x