The disease activity score in 28 joints (DAS28) based on C-reactive protein (CRP) is comparable to the DAS28 based on the erythrocyte sedimentation rate (ESR) for assessment of disease progression in patients with rheumatoid arthritis (RA), study findings indicate.
Despite this, the researchers warn that users should be aware of a nonsignificant tendency for the DAS28-CRP to yield a better response than the DAS28-ESR.
The DAS28 is typically based on ESR, but more recently an alternative formulation of the DAS28, based on CRP has been developed, explain George Wells (University of Ottawa, Canada) and colleagues.
The CRP method may be preferable to ESR because CRP measurements are routinely used in clinical practice, are more sensitive to short-term changes in disease activity, and can be obtained faster than the ESR, say the researchers.
To validate and compare the definition of the DAS28 based on CRP to the definition based on ESR, Wells and team analyzed data from two clinical trials in patients with RA.
They found that there was 82.4% agreement in classifying patients as none, moderate, or good European League Against Rheumatism (EULAR) responders using the two DAS28 definitions. When disagreements occurred, the DAS28-CRP yielded a better EULAR response state more often than DAS28-ESR (12.6% vs 4.9%, respectively).
There was also good agreement in determining remission (DAS28 of less than 2.6), with the majority of discrepancies (33 of 752 cases) due to patients being classified as in remission with DAS28-CRP but not with DAS28-ESR.
For both DAS28-ESR and DAS28-CRP, radiographic progression decreased with improving EULAR state (from none to moderate to good) in patients, while the improvement in Health Assessment Questionnaire Disability Index increased across the EULAR states.
Wells and co-authors conclude in the Annals of Rheumatic Diseases: “Both definitions of the DAS28 criteria can be used as benchmarks to assess patient improvement and treatment effect, and can aid in the description and interpretation of changes in disease activity in patients with RA.”
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What a great post! This was always about as clear as mud to me and now, finally, I understand! Thank-you Lynn, (cut and paste time!)
You're welcome
Unfortunately, it didn't work that way for me. Both labs were negative, physical exam was negative and I still had damage occuring, including a torn tendon in my wrist. RA symptoms and complications just don't follow the rule book in my case. Lindythat is really troubling me, LinB... I'm sure it is you too...
what went wrong? why can all the evidence point to remission and you are still losing ground....... is it at all possible the erosions occured before actual remission happened???
Hi Babs, I had xrays done 1 year ago and an MRI done 2 years ago. I was supposedly in clinical remission for about 18 months. There was mucho damage done in those 18 months once the xray and MRIs were compared. There really isn't any answer to this. My RF, Sed, CPR are still negative. I had them done 2 weeks ago, same time I had the MRI done. I've had hand, feet, knees, wrist and shoulder joint pain for the last 10 weeks. Have I reverted to seronegative? Is that even possible? I have some research to do but I'm so tired of it all. That's why we went to Vegas for 4 days - to get away from doctors, labs, etc. I'm back on Mxt and Sulfasalazine and may add another DMARD. I think I'll start researching next week and a second opinion is still on the table. Haven't ruled it out yet. LindyI'm so sorry.... I wish it wasn't like this for you..
can you become sero=negative? IDK..I've always been sero=neg.
This has been one of my big questions throughout trying to decide to start meds. The only abnormal blood work I've had is RF Factor and both rheumy's I've seen have said they "have never seen joint damage without inflammation OR clear visible swelling of the joints". In my case, I have neither so I'm reluctant to start anything.....the doctor's have said "it is my choice and they could go either way". Makes it easy heh? :)
I do have an MRI scheduled for next month so will be curious to see if they find anything.
Believe me you can have erosions with normal RF, CRP, and sed rate. I have the MRIs to prove it. I never would have believed it was possible but I've come to the conclusion that nothing about this disease follows any sort of plan. Anything can happen. LindyJust a thought. MRI has advanced alot over the years. Do you think it is posible that years ago you had damage and it just didn't show up on the MRI.Hi Milly, I had an MRI about 2 years ago and xrays about a year after that. LindyBummer!! Hope things get worked out for you.
[QUOTE=LinB]Believe me you can have erosions with normal RF, CRP, and sed rate. [/QUOTE]
Lindy, like you, I had heard that normal lab values equated with no on-going damage. I have taken your very expensive lesson to heart and will be diligent about requesting x-rays if they are not ordered routinely.
Thank you for sharing your herstory with all of us.LinB.......did you have obvious swelling even though your blood work was normal?I had no swelling or inflammation on physical exam. That's one of the criteria for being in clinical remission. Apparently I had very small amounts of synovial fluid and damage was occuring.
Shug, it pays to be diligent. I thought I was but probably not. Also, may have had a little bit of denial going on when I was aching and a little sore because labs were normal. Take nothing for granted. Lindy
Lindy
[QUOTE=Spelunker] [QUOTE=LinB]Believe me you can have erosions with normal RF, CRP, and sed rate. [/QUOTE]
Lindy, like you, I had heard that normal lab values equated with no on-going damage. I have taken your very expensive lesson to heart and will be diligent about requesting x-rays if they are not ordered routinely.
Thank you for sharing your herstory with all of us.[/QUOTE]
welll... this makes perfect sense to me! I always have normal blood markers... and yet have erosions.....
A lot of information in this post
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