DAS28 and Rheumatoid Arthritis: The Need for Standardization.

Disease Activity Score in 28 Joints (DAS28) scoring in rheumatoid arthritis (RA) is now recommended as a basis for clinical decisions about treatment initiation and alteration. The British Society of Rheumatology suggests that most RA patients should have a DAS28 assessment at every clinic visit, to monitor disease activity and the impact of therapy. Establishing an accurate baseline assessment of DAS28, with regular re-evaluation, is considered crucial, so that progress towards a defined target of remission (or low disease activity) can be measured. The Treat-to-Target initiative, launched in March 2010, is now impacting on clinical practice throughout the UK and Europe. One of its key recommendations is that patients should be regularly monitored using validated composite measures of disease activity that include joint assessments. DAS28 is recommended as one of the most useful of these methods but, although it is becoming more widely adopted and training is ongoing, supported by materials produced by the European League Against Rheumatism (EULAR), the variability inherent in the four components of DAS28 means that standardization of practice methods is now an important issue. This short report details some of the pitfalls that can occur when applying DAS28 in clinical practice and suggests some workable solutions to enable departments to set up their own standard operating procedure.