Mechanisms of Fibril Formation and Cellular Response
Martha Skinner, John L. Berk, Lawreen H. Connors, David C. Seldin in XIth International Symposium on Amyloidosis, 2007
The DAS28 is a well validated score relating to outcome in rheumatoid arthritis. All 76 patients who were assessed by this had an established diagnosis of rheumatoid arthritis. The laboratory results which correlate best should perhaps be paramount in any conclusion. The patient global score, on the other hand, while widely used can have two disadvantages: first it may reflect the patient’s view of their condition in respect of symptoms related to joint damage rather than inflammation; second, it is recognised that some patients don’t cope well with the concept of visual analogue scores. The physician’s assessment was specifically designed to reflect clinically evident inflammation and, though not validated, should give a good guide as to the most relevant laboratory marker for inflammation. The correlation of patient global solely with CRP, the DAS28 best with CRP, and better correlations of the physician’s score with CRP and ESR taken together suggest that CRP is the best routine objective measurement that is likely to be available in patients’ records. These results suggest that identifying those patients who have high CRP levels over prolonged periods (CRP x time) is the best means of identifying those who are most at risk of AA amyloid because of chronic inflammatory disease.
Anticytokine therapies in rheumatic diseases: an update
Rajan Madhok, Hilary Capell in The Year in Rheumatic Disorders Volume 4, 2004
RA runs a variable course but in most patients it has a poor long-term outcome, with significant disability and increased mortality. DMARDs prevent articular damage and functional deterioration; however, a sizeable proportion of patients have an incomplete clinical response, while about 10% of all RA patients are DMARD- resistant. Therefore, it is important to consider therapy with biological agents in all patients with highly active, refractory disease, not only to control the symptoms but also to improve the disease outcome. To ensure consistency across different centres, it has been agreed that severe disease activity should be properly defined using an appropriate index. To this end, in Europe the disease activity score based on a 28-joint count (DAS28) has been chosen. The DAS28 is a composite index that takes into account four variables: tender joint count, swollen joint count, erythrocyte sedimentation rate and the patient's global assessment of disease activity. In the UK, a DAS28 higher than 5.1 denotes highly active disease and is an indication for anti- TNF-a therapy if at least two DMARDs, including MTX, have been ineffective or poorly tolerated.
Management of Psoriatic Arthritis
Siba P. Raychaudhuri, Smriti K. Raychaudhuri, Debasis Bagchi in Psoriasis and Psoriatic Arthritis, 2017
Because patients with PsA are mostly associated with significant peripheral arthritis, we often apply the same outcome measures developed and validated for RA [20]. These include the Disease Activity Score for 28 joints (DAS28) and the American College of Rheumatology (ACR) Responder Index (ACR20) [21,22]. But, the difference in the pattern of joint involvement between PsA and RA has raised serious questions about the ability of ACR20 and DAS28 to quantify the disease activity of PsA. For example, compared with RA in PsA, there is a greater tendency for asymmetric and oligoarticular joint involvement. Moreover, the distal interphalangeal (DIP) joints are frequently involved in PsA but not in RA—a remarkable feature because the 28-joint count comprising the DAS28 excludes the finger (DIP) joints, as well as the ankles and feet, which are commonly affected in PsA [21]. So, in patients with oligoarthritis, use of the DAS28 can misclassify 20% of PsA patients and application of DAS28 will simply mismeasure disease activity in these patients [23]. As a result of this fallacy for PsA clinical trials, it has been recommended to do a count of 68 tender and 66 swollen joints, including the DIP joints of the hands [24].
Authors’ reply
Published in Scandinavian Journal of Rheumatology, 2020
O Hofstedt, D Di Giuseppe, G-M Alenius, N Stattin, H Forsblad-D’Elia, L Ljung
Regarding the Bland–Altman plots, we agree with Dr Madsen that a more in-depth discussion of the visualized results would have been interesting, such as the above discussion of the limits of agreement, which unfortunately was hindered by the article type. Thus, we only stated the observation regarding proportional bias. As the presented results indicate, there is considerable variability in the VAS measurements, visualized here, as suggested by Dr Madsen, with a correlation plot for VAS global (Figure 1). Assessment of the agreement regarding the 28-joint count Disease Activity Score (DAS28) is another way of evaluating the methods, which may have more clinical relevance. Using the suggested correlation plot for DAS28, the excellent agreement becomes clear (Figure 2). Furthermore, when evaluating the disease activity categories only one patient (marked with a black dot) had a different classification depending on the method of VAS collection.
A randomized clinical trial for the assessment of the efficacy and safety of guluronic acid (G2013) in patients with rheumatoid arthritis
Published in Immunopharmacology and Immunotoxicology, 2019
Shahin Khadem Azarian, Maassoumeh Akhlaghi, Mahdi Mahmoudi, Shayan Mostafaei, Ahmad Reza Jamshidi, Sepideh Nazeri, Abbas Mirshafiey
Of the 52 randomized patients, 26 were assigned to guluronic acid, 26 to conventional group (Figure 1). Baseline demographic and disease characteristics were generally comparable between the treatment groups (Table 1), and there were no statistically meaningful differences between the treatment groups for any of the evaluated characteristics. The majority of patients completed the study through week 12 (84.61% in the guluronic acid group, 84.61% in the conventional group). Before the starting of the study, all patients had high disease activity (DAS28 score of higher than 5.1 is indicative of high disease activity, whereas a DAS28 below 3.2 indicates low disease activity as well as DAS28 < 2.6 indicates the proportion of patients who were achieving disease remission). The majority of patients enrolled in this study were female (76.9%) and the mean age of the patients was 45.58 ± 12.68 years, and the mean disease duration was 5.76 ± 4.02 years.
Evaluation of retinal vascularization by optical coherence tomography angiography (OCTA) in rheumatoid arthritis, and its relationship with disease activity
Published in Modern Rheumatology, 2021
Koray Ayar, Mehmet Erol Can, Nizameddin Koca, Direnç Şerif Çelik
The disease activity of RA patients was measured using the DAS28 (Disease Activity Score). DAS28 is calculated using the number of tender and swollen joints, patient global health assessment (PGHA), and erythrocyte sedimentation rate (ESR). Physical examinations of the small joints of the hands and joints of the wrist, knee, shoulder, and elbow (28 joints) were performed by a single experienced rheumatologist to see if the joints were tender or swollen. PGHA was assessed by asking patients to respond to the question, ‘Considering all the ways your arthritis has affected you how do you feel today?’ using a visual analog scale (VAS). DAS28-ESR was calculated according to this formula; DAS28-ESR = (0.56 × square (tender joint count))+(0.28 × square (swollen joint count))+(0.7 × ln (ESR))+(0.014 × PGHA).
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