Other RA assessment Tools

Other Tools

Many rheumatologists use the CDAI, SDAI or DAS to stratify patients in to four groups according to disease activity.

CDAI = Patient global (/10) + Physician Global (/10) + SJC 28 + TJC 28*

SDAI = CDAI + CRP mg/dl (up to 10)

DAS28: In order to calculate the DAS28, information about some disease variables is needed.

· Number of swollen joints *

· Number of tender joints *

· Erythrocyte Sedimentation Rate (ESR)

· Patient’s “global disease activity” measured on a Visual Analogue Scale of 100 mm

*Based on 28 joints; shoulders, elbows, wrists, MCPs PIPs, knees

DAS28 = 0.56 * sqrt(tender28) + 0.28 * sqrt(swollen28) + 0.70 * ln(ESR) + 0.014 *

 

 

DISEASE ACTIVITY CDAI DAS
REMISSION < 2.8
LOW 2.8 – 10  < 3.2
MODERATE 10 – 22 3.2 – 5.1
HIGH >22 > 5.2

 

 

Remission and Response

The ACR criteria for clinical remission in rheumatoid arthritis:

Five or more of the following requirements must be fulfilled for at least 2 consecutive months

1. Duration of morning stiffness not exceeding 15 minutes

2. No fatigue

3. No joint pain (by history)

4. No joint tenderness or pain in motion

5. No soft tissue swelling in joints or tendon sheaths

6. Erythrocyte sedimentation rate (Westergren method) < 30 mm/h for a female or 20 mm/h for a Male

 

EULAR remission criteria recommend use of either of the following definitions as the primary and the other as a secondary outcome measure:

SDAI ≤3.3

OR

All of the following:

Swollen and tender joint counts (using 28 joint count) each ≤1

Patient global assessment (on a 0 to 10 scale) ≤1

CRP (expressed in mg/dL) ≤1

 

For clinical practice consider using :

CDAI ≤2.8

 

Using DAS

For improvement from baseline

Good > 1.2

Moderate > 0.6 < 1.2

None < 0.6