Interpretation of DAS28 and its components in the assessment of inflammatory and non-inflammatory aspects of rheumatoid arthritis

Background: DAS28 is interpreted as the inflammatory disease activity of RA. Non-inflammatory pain mechanisms can confound assessment. We aimed to examine the use of DAS28 components or DAS28-derived measures that have been published as indices of non-inflammatory pain mechanisms, to inform interpre...

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Main Authors:	McWilliams, Daniel F., Kiely, Patrick D.W., Young, Adam, Joharatnam, Nalinie, Wilson, Deborah, Walsh, David A.
Format:	Article
Language:	English
Published:	BioMed Central 2018
Online Access:	http://eprints.nottingham.ac.uk/50461/ http://eprints.nottingham.ac.uk/50461/ http://eprints.nottingham.ac.uk/50461/ http://eprints.nottingham.ac.uk/50461/8/s41927-018-0016-9.pdf

id	nottingham-50461
recordtype	eprints
spelling	nottingham-504612018-04-05T09:17:10Z http://eprints.nottingham.ac.uk/50461/ Interpretation of DAS28 and its components in the assessment of inflammatory and non-inflammatory aspects of rheumatoid arthritis McWilliams, Daniel F. Kiely, Patrick D.W. Young, Adam Joharatnam, Nalinie Wilson, Deborah Walsh, David A. Background: DAS28 is interpreted as the inflammatory disease activity of RA. Non-inflammatory pain mechanisms can confound assessment. We aimed to examine the use of DAS28 components or DAS28-derived measures that have been published as indices of non-inflammatory pain mechanisms, to inform interpretation of disease activity. Methods: Data were used from multiple observational epidemiology studies of people with RA. Statistical characteristics of DAS28 components and derived indices were assessed using baseline and follow up data from British Society for Rheumatology Biologics Registry participants [1] commencing anti-TNF therapy (n = 10813), or [2] changing between non-biologic DMARDs (n=2992), [3] Early Rheumatoid Arthritis Network participants (n=813), and [4] participants in a cross-sectional study exploring fibromyalgia and pain thresholds (n=45). Repeatability was tested in 34 patients with active RA. Derived indices were the proportion of DAS28 attributable to patient-reported components (DAS28-P), tender-swollen difference and tender:swollen ratio. Pressure pain detection threshold (PPT) was used as an index of pain sensitisation. Results: DAS28, tender joint count, visual analogue scale, DAS28-P, tender-swollen difference and tender:swollen ratio were more strongly associated with pain, PPT and fibromyalgia status than were swollen joint count or erythrocyte sedimentation rate. DAS28-P, tender-swollen difference and tender:swollen ratio better predicted pain over 1 year than did DAS28 or its individual components. Conclusions: DAS28 is strongly associated both with inflammation and with patient-reported outcomes. DAS28-derived indices such as tender-swollen difference are associated with non-inflammatory pain mechanisms, can predict future pain and should inform how DAS28 is interpreted as an index of inflammatory disease activity in RA. BioMed Central 2018-03-23 Article PeerReviewed application/pdf en cc_by http://eprints.nottingham.ac.uk/50461/8/s41927-018-0016-9.pdf McWilliams, Daniel F. and Kiely, Patrick D.W. and Young, Adam and Joharatnam, Nalinie and Wilson, Deborah and Walsh, David A. (2018) Interpretation of DAS28 and its components in the assessment of inflammatory and non-inflammatory aspects of rheumatoid arthritis. BMC Rheumatology, 2 (8). pp. 1-12. ISSN 2520-1026 https://bmcrheumatol.biomedcentral.com/articles/10.1186/s41927-018-0016-9 doi:10.1186/s41927-018-0016-9 doi:10.1186/s41927-018-0016-9
repository_type	Digital Repository
institution_category	Local University
institution	University of Nottingham Malaysia Campus
building	Nottingham Research Data Repository
collection	Online Access
language	English
description	Background: DAS28 is interpreted as the inflammatory disease activity of RA. Non-inflammatory pain mechanisms can confound assessment. We aimed to examine the use of DAS28 components or DAS28-derived measures that have been published as indices of non-inflammatory pain mechanisms, to inform interpretation of disease activity. Methods: Data were used from multiple observational epidemiology studies of people with RA. Statistical characteristics of DAS28 components and derived indices were assessed using baseline and follow up data from British Society for Rheumatology Biologics Registry participants [1] commencing anti-TNF therapy (n = 10813), or [2] changing between non-biologic DMARDs (n=2992), [3] Early Rheumatoid Arthritis Network participants (n=813), and [4] participants in a cross-sectional study exploring fibromyalgia and pain thresholds (n=45). Repeatability was tested in 34 patients with active RA. Derived indices were the proportion of DAS28 attributable to patient-reported components (DAS28-P), tender-swollen difference and tender:swollen ratio. Pressure pain detection threshold (PPT) was used as an index of pain sensitisation. Results: DAS28, tender joint count, visual analogue scale, DAS28-P, tender-swollen difference and tender:swollen ratio were more strongly associated with pain, PPT and fibromyalgia status than were swollen joint count or erythrocyte sedimentation rate. DAS28-P, tender-swollen difference and tender:swollen ratio better predicted pain over 1 year than did DAS28 or its individual components. Conclusions: DAS28 is strongly associated both with inflammation and with patient-reported outcomes. DAS28-derived indices such as tender-swollen difference are associated with non-inflammatory pain mechanisms, can predict future pain and should inform how DAS28 is interpreted as an index of inflammatory disease activity in RA.
format	Article
author	McWilliams, Daniel F. Kiely, Patrick D.W. Young, Adam Joharatnam, Nalinie Wilson, Deborah Walsh, David A.
spellingShingle	McWilliams, Daniel F. Kiely, Patrick D.W. Young, Adam Joharatnam, Nalinie Wilson, Deborah Walsh, David A. Interpretation of DAS28 and its components in the assessment of inflammatory and non-inflammatory aspects of rheumatoid arthritis
author_facet	McWilliams, Daniel F. Kiely, Patrick D.W. Young, Adam Joharatnam, Nalinie Wilson, Deborah Walsh, David A.
author_sort	McWilliams, Daniel F.
title	Interpretation of DAS28 and its components in the assessment of inflammatory and non-inflammatory aspects of rheumatoid arthritis
title_short	Interpretation of DAS28 and its components in the assessment of inflammatory and non-inflammatory aspects of rheumatoid arthritis
title_full	Interpretation of DAS28 and its components in the assessment of inflammatory and non-inflammatory aspects of rheumatoid arthritis
title_fullStr	Interpretation of DAS28 and its components in the assessment of inflammatory and non-inflammatory aspects of rheumatoid arthritis
title_full_unstemmed	Interpretation of DAS28 and its components in the assessment of inflammatory and non-inflammatory aspects of rheumatoid arthritis
title_sort	interpretation of das28 and its components in the assessment of inflammatory and non-inflammatory aspects of rheumatoid arthritis
publisher	BioMed Central
publishDate	2018
url	http://eprints.nottingham.ac.uk/50461/ http://eprints.nottingham.ac.uk/50461/ http://eprints.nottingham.ac.uk/50461/ http://eprints.nottingham.ac.uk/50461/8/s41927-018-0016-9.pdf
first_indexed	2018-09-06T14:13:48Z
last_indexed	2018-09-06T14:13:48Z
_version_	1610867779453321216

Interpretation of DAS28 and its components in the assessment of inflammatory and non-inflammatory aspects of rheumatoid arthritis

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