Discordance between 28-joint count Disease Activity Score based on C-reactive protein (DAS28-CRP) and DAS28 based on erythrocyte sedimentation rate (DAS28-ESR) in rheumatoid arthritis (RA) can be significantly improved by adjusting scores by gender, according to a study published in Rheumatology.
In the current study, researchers evaluated the determinants of discordance between scores of the DAS28-ESR and DAS28-CRP and the resulting effect on RA disease activity stratification and treat-to-target approaches. Investigators analyzed 31,074 DAS28-ESR and DAS28-CRP scores from the British Society for Rheumatology Biologics Register for RA.
For the entire cohort, DAS28-CRP scores were an average of 0.3 points lower than corresponding DAS28-ESR scores. The greatest differences between DAS28-ESR and DAS28-CRP scores were seen in women (-0.35) and patients >50 years (-0.34), whereas mean DAS28-CRP scores for men were only 0.15 lower than equivalent DAS28-ESR scores. The discordance between DAS28-ESR and DAS28-CRP scores had a significant effect on disease activity stratification at remission thresholds and low disease activity (66.6% and 32.0% concordance, respectively). Adjusting DAS28-CRP scores according to gender significantly improved the agreement with DAS28-ESR scores (P <.001).
Study investigators concluded, “Our findings suggest the DAS28-ESR and DAS28-CRP should not be used interchangeably when stratifying disease activity. Gender influences inter-score agreement, and adjustment of the DAS28-CRP according to gender significantly improves inter-score reliability.”
One author reported receipt of honoraria and providing consultancy. See original article for further details.
Hamann PDH, Shaddick G, Hyrich K, Green A, McHugh N, Pauling JD. Gender stratified adjustment of the DAS28-CRP improves inter-score agreement with the DAS28-ESR in rheumatoid arthritis [published online December 19, 2018]. Rheumatology (Oxford). doi: 10.1093/rheumatology/key374