Disease Activity Score 28 (DAS28) using C-reactive protein underestimates disease activity and overestimates EULAR response criteria compared with DAS28 using erythrocyte sedimentation rate in a large observational cohort of rheumatoid arthritis patients in Japan. Issue 9 (16th March 2007)

• Record Type: Journal Article
• Authors: Matsui, Toshihiro; Kuga, Yoshiaki; Kaneko, Atsushi; Nishino, Jinju; Eto, Yoshito; Chiba, Noriyuki; Yasuda, Masayuki; Saisho, Koichiro; Shimada, Kota; Tohma, Shigeto
• Is Part Of: Annals of the rheumatic diseases. Volume 66:Issue 9(2007)
• Page Start: 1221
• Page End: 1226
• Publication Date: 2007-03-16
• Subjects: CRP, C-reactive protein -- DAS28, Disease Activity Score 28 -- ESR, -- erythrocyte sedimentation rate, -- mHAQ, modified health assessment questionnaire -- RA, rheumatoid arthritis -- VAS, visual analogue scale; Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/ard.2006.063834
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Objectives: To compare disease activity and the improvement of disease activity evaluated between by Disease Activity Score 28 using erythrocyte sedimentation rate (DAS28-ESR) and by DAS28 using C-reactive protein (DAS28-CRP) in Japanese patients with rheumatoid arthritis (RA). Methods: Data from 3073 RA patients registered in the large cohort database ( NinJa : National Database of Rheumatic Diseases by iR-net in Japan) of 2003 was used to calculate DAS28-ESR and DAS28-CRP and disease activities were evaluated. Improvements in disease activities were also evaluated according to the European League Against Rheumatism (EULAR) response criteria in 1482 RA patients whose DAS28-ESR and DAS28-CRP could be calculated from data for both 2002 and 2003. Results: The mean value of DAS28-CRP (3.59, SD 1.25) was significantly smaller than that of mean DAS28-ESR (4.31, SD 1.32) (p < 0.0001). The number of patients who satisfied the criteria of remission was 297 (9.7%) in DAS28-ESR versus 705 (22.9%) in DAS28-CRP and the number of patients with high disease activity was 842 (27.4%) versus 357 (11.6%) for DAS28-ESR and DAS28-CRP, respectively; there was a significant difference between the two (p < 0.0001). Change of respective DAS28 was significantly correlated (ΔDAS28-ESR −0.05, SD 1.14 versus ΔDAS28-CRP −0.10, SD 1.10) (p < 0.0001); however, the number of "good response" patients was significantly different (p < 0.03) between DAS28-ESR (97 patients, 6.5%) and DAS28-CRP (136 patients, 9.2%). Conclusions: DAS28-CRP significantly underestimated disease activity and overestimated the improvement in disease activity compared with DAS28-ESR. DAS28-CRP should be evaluated using different criteria from that for DAS28-ESR.