Assessing Disease Activity

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??