The Disease Activity Score and the EULAR Response Criteria

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The Disease Activity Score

The DAS was originally developed as an index containing the Ritchie Articular Index (RAI, range, 0–78), a 44 swollen joint count (range, 0–44), ESR, and a patient global assessment on a visual analog scale (range, 0–100).2, 3 A specially programmed DAS calculator and a computer program that can be downloaded from the Internet are available to calculate the DAS (Table 1). The DAS has a continuous scale ranging from 0 to 10, and usually shows a Gaussian distribution in populations that have RA (

Development and validity of the Disease Activity Score (DAS28)

The DAS28 is an index similar to the original DAS, consisting of a 28 tender joint count (range, 0–28), a 28 swollen joint count (range, 0–28), ESR, and facultatively, a patient global assessment on a visual analog scale (range, 0–100) (Table 2).3 Because of the use of reduced and nongraded joint counts, the DAS28 is easier to complete than the DAS. The DAS28 has a continuous scale ranging from 0 to 9.4, and usually shows a Gaussian distribution in RA populations. DAS and DAS28 values cannot be

Development and validity of the EULAR response criteria

The EULAR response criteria incorporate the amount of change, and a certain level of disease activity,7, 22 much like the newly developed ACR hybrid response criteria.23 The EULAR response criteria classify patients as good, moderate, or nonresponders, using the individual amount of change in DAS and the level (low, moderate, or high) of DAS reached (Table 3).5 A change of 1.2 (two times the measurement error of 0.6) of the DAS in an individual patient is considered a significant change.5 For

Use of the Disease Activity Score and EULAR criteria in clinical trials

Although the ACR improvement criteria and the DAS-based EULAR response criteria use a different approach, both perform well in distinguishing placebo from active treatment and in discriminating between two types of active treatment.7, 24 The DAS-based EULAR response criteria were developed to compare treatments in clinical trials, but the DAS can also be used for this purpose as a continuous end point; then, the difference between two drugs or drug and placebo can readily be interpreted in

Using the Disease Activity Score in clinical practice

For clinical practice, experts generally agree that rheumatoid inflammation should be controlled as soon as possible and as completely as possible, and that control should be maintained for as long as possible, consistent with patient safety.26 With the goal of treatment to attain and sustain low disease activity or even remission, the management of RA should clearly include systematic and regular quantitative evaluation of rheumatoid inflammation.27 These principles are now widely known as

Discussion

RA is a multifaceted disorder, and therefore measurement of multiple outcomes is relevant to its management, including disease activity, disability, and joint damage.29 The core-set of outcome measures to be used in RA clinical trials of DMARDs illustrates this, including a measure for joint damage, a measure for disability, and six measures to reflect the underlying disease activity.29 The complexity of finding a single representative outcome measure for RA disease activity is related to that

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    A version of this article originally appeared in the 21:4 issue of Best Practice & Research: Clinical Rheumatology.

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