Leeb Burkhard F, Haindl Pia M, Maktari Adil, Nothnagl Thomas, Rintelen Bernhard
2nd Department of Medicine, Center for Rheumatology, State Hospital Korneuburg-Stockerau, Karl Landsteiner Institute for Clinical Rheumatology; A-2000 Stockerau, Landstrasse 18, Austria.
J Rheumatol. 2007 Dec;34(12):2382-7. Epub 2007 Nov 1.
To determine if the Disease Activity Index including a 28-joint count (DAS28) is equally applicable for the total population with rheumatoid arthritis (RA).
Five hundred fifty-seven outpatients with RA [432 women, 125 men; median age 64 yrs (range 0-85), median disease duration 48 mo (range 2-548)] were enrolled consecutively into this cross-sectional study. DAS28, physician's global assessment of disease activity, patient's assessment of pain on visual analog scale, C-reactive protein (mg/dl), rheumatoid factor (RF), and disease duration were recorded. t-tests were applied for all comparisons of DAS28 values. Linear regression analysis was performed for each confounding factor.
The mean DAS28 in female patients was 3.66 +/- 0.57 SEM, and in males 3.01 +/- 1.12 (p < 0.001). DAS values in patients with early RA (< 37 mo) were significantly higher than in patients with advanced RA (3.62 +/- 0.67 vs 3.37 +/- 0.81, respectively; p < 0.017). Regression analysis revealed a highly significant relationship between DAS28 score and patient's pain rating (r = 0.592, p < 0.0001). Pain exerted the greatest influence on the DAS28 (p < 0.0001), while of the other factors only age (p < 0.008 for females, p < 0.007 for males) was also significantly correlated with the DAS28 values.
DAS28 values differ considerably depending primarily on the patient's pain perception and gender and to a lesser degree on patient's age, whereas results for disease duration and RF were inconclusive.
确定包括28个关节计数的疾病活动指数（DAS28）是否同样适用于类风湿关节炎（RA）的所有患者。
557例类风湿关节炎门诊患者[432例女性，125例男性；年龄中位数64岁（范围0 - 85岁），病程中位数48个月（范围2 - 548个月）]连续纳入本横断面研究。记录DAS28、医生对疾病活动的整体评估、患者视觉模拟量表疼痛评分、C反应蛋白（mg/dl）、类风湿因子（RF）及病程。对DAS28值的所有比较采用t检验。对每个混杂因素进行线性回归分析。
女性患者的平均DAS28为3.66±0.57标准误，男性为3.01±1.12（p < 0.001）。早期类风湿关节炎（< 37个月）患者的DAS值显著高于晚期类风湿关节炎患者（分别为3.62±0.67和3.37±0.81；p < 0.017）。回归分析显示DAS28评分与患者疼痛评分之间存在高度显著相关性（r = 0.592，p < 0.0001）。疼痛对DAS28的影响最大（p < 0.0001），而其他因素中只有年龄（女性p < 0.008，男性p < 0.007）也与DAS28值显著相关。
DAS28值差异很大，主要取决于患者的疼痛感知和性别，在较小程度上取决于患者年龄，而病程和RF的结果尚无定论。
