1 Assessing Disease Activity Janice Booth Rheumatology Nurse Practitioner January 2012

2 Disease Specific RA – DAS28,ACR 20/50/70 Psoriatic Arthritis – PSARC Ankylosing Spondylitis – BSADAI, BASFI, BASMI.

3 The DAS 28 What is it? Why is it done? What the results mean? Limitations.

4 What is it? Measure of disease activity. Includes the number of swollen and tender joints, blood results, how you feel. Calculated – gives your arthritis a score.

5 Why is it done? Assess response to treatment. Assess eligibility for biologic treatments. Documents your progress. Outcome measure, provides evidence. Standardised assessment - used in research.

6 How is it Done Dr / Nurse assess joints (28 in total). Blood test ESR / CRP = measures of inflammation. Global Score – how active your arthritis is on a 100mm line (0 – 100).

7 What do we mean by ‘Active’ NOT How active you are. BUT How bad is your arthritis at present? How inflamed are your joints? and how you feel? (Flare ups). Pain measured separately to ‘activity’.

8 What do the results mean? Less than 2.6 = Remission. 2.6 – 3.2 = Low Disease Activity. More than 3.2 = may indicate a need to change treatment. More than 5.1 = High Disease Activity.

9 Limitations. Subjective – relies on how individual feels and their understanding what is being measured / asked. Differences between early and advanced arthritis. False highs and lows – interpretation needs clinical judgement. Doesn’t include feet. Not the perfect tool.

10 Considerations. DAS assessment only a small part of your overall assessment. Needs clinical interpretation. Requires some skill and knowledge and standardisation within Rheumatology departments.

11 Thank you. Any Questions??