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Rank: Advanced Member
Groups: Registered
Joined: 12/4/2009
Posts: 2,127
Location: Thornton Cleveleys
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Hi Guys I'm posting this as it has come up on a couple of threads in the last few weeks. Several studies have been undertaken and each concluded that the results from the DAS28 are as valid as disease activity scores that include more comprehensive joint counts. Originally posted a few years ago. 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 has been 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 treatment 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.
Hope this is helpful to someone! Lyn x
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Rank: Advanced Member  Groups: Registered
Joined: 10/21/2010 Posts: 69 Location: North Devon
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This is very useful. At my nurse appointment on Thursday she said to me, now think about how your joints are really feeling before you answer. I think sometimes you can almost used to having a little pain or discomfort, but let's face it if you are taking the drugs and painkillers, you should report the slightest tender spot or pain of any sort. So I was surprised when after thinking about it and she took my DAS that I was in fact worse than the last time! although I think on a general scale I might have said I was feeling better. It was only when she got prodding about that I thought about how each individual joint and digit felt like. Am I rambling, I am tired now. Very useful though. Julie Good advice is best followed by the art of listening
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Rank: Advanced Member  Groups: Registered
Joined: 12/3/2009 Posts: 1,110 Location: London
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Thanks for that Lyn, it does explain alot really. Well done for being a guinea pig!! it gives the rest of us a chance to understand the DAS.  BARBARA
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Rank: Advanced Member  Groups: Registered
Joined: 2/18/2010 Posts: 1,098 Location: farningham kent
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Thanks Lyn for clearing up this issue about our feet ! All useful info as ever Julia x
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