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

• Published in: Annals of the rheumatic diseases Vol. 66; no. 9; pp. 1221 - 1226
• Main Authors: Matsui, Toshihiro, Kuga, Yoshiaki, Kaneko, Atsushi, Nishino, Jinju, Eto, Yoshito, Chiba, Noriyuki, Yasuda, Masayuki, Saisho, Koichiro, Shimada, Kota, Tohma, Shigeto
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.09.2007; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Age; Aged; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - blood; Arthritis, Rheumatoid - drug therapy; Biological and medical sciences; Biomarkers - blood; Blood Sedimentation; C-reactive protein; C-Reactive Protein - analysis; Clinical medicine; Cohort Studies; Cross-Sectional Studies; CRP; DAS28; Data collection; Disease; Disease Activity Score 28; Disease Progression; Diseases of the osteoarticular system; Drugs; erythrocyte sedimentation rate; ESR; Extended Report; Female; Glucocorticoids - therapeutic use; Health risk assessment; Hospitalization; Hospitals; Humans; Inflammatory joint diseases; Japan; Male; Medical sciences; mHAQ; Middle Aged; modified health assessment questionnaire; Patients; Rheumatic diseases; Rheumatoid arthritis; Rheumatology; Severity of Illness Index; Treatment Outcome; Tuberculosis; VAS; visual analogue scale; Web sites; Asia; Japan; Human; Immunopathology; Chronic; Sedimentation rate; Evaluation scale; Activity index; Rheumatoid arthritis; Diseases of the osteoarticular system; Autoimmune disease; Inflammatory joint disease; C reactive protein
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.2006.063834

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.