| Background and objectiveRheumatoid arthritis (RA) is a systemic autoimmune disease of unknown etiology characterized by symmetric, erosive synovitis. The pathological characteristic of RA includes synovial hyperplasia and inflammation, pannus formation, in the end bone erosion, cartilage loss and joint destruction. If left untreated, it would lead to joint damage and disability. It is important to initiate therapy promptly. To ensure that therapy is effective, frequent clinical assessments are needed.The disease activity score uses28joint counts (DAS28) has been widely used to monitor disease activity of patients with rheumatoid arthritis. Many researches about RA showed that, compared with routine care, systematic disease activity score driven therapy results in significantly better clinical improvement and possibly improves the suppression of joint damage progression. The DAS28is calculated from four components:tender joint count (TJC), swollen joint count (SJC), the laboratory parameter erythrocyte sedimentation rate (ESR) and visual analogue scale (VAS) score of the patient’s global health (GH). Cut-off points of2.6,3.2and5.1have been proposed to be indicative of remission, low disease activity and high disease activity, respectively.Recently, a DAS28based on C-reactive protein (CRP) levels rather than ESR has been suggested. Although the formula for calculating DAS28-CRP values was designed to produce equivalent results to those of the DAS28-ESR, DAS28-CRP values seem to be lower than DAS28-ESR values in clinical practice. Because changes in ESR and CRP levels represent different underlying pathophysiologies, clinical significance of the DAS28-CRP might be differ from those of the DAS28-ESR. At present, some studies have been performed in foreign to compare these two systems, our country yet have not. This study is aimed to evaluate the relationship between DAS28-CRP and DAS28-ESR.Subject and methods222patients, who fulfilled the2009American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for RA, were enrolled. The collected data for each patient with RA was name, sex, age, disease duration and information collected on an arbitrary day in daily clinical practice:the number of tender and swollen joints, patient’s global and pain VAS, ESR, CRP, use of corticosteroids (GCs), disease-modifying antirheumatic drugs (DMARDs) and non-steroidal anti-inflammatory drugs (NSAIDs). Then calculate the values of DAS28-ESR and DAS28-CRP. The relationship between them was analyzed.Results(1) There was a significant linear correlation relationship between DAS28-ESR and DAS28-CRP (P<0.05), with correlation coefficient0.968.(2) Both DAS28-CRP (3.33±1.68) and DAS28-ESR (3.88±1.78) scores were distributed normally (P>0.05), with the peak of the DAS28-CRP distribution being to the left of that of the DAS28-ESR, with significant statistical difference (P<0.05).(3) The study showed that17(accounting for28.3%of60cases) of the60 patients who showed’moderate disease activity’ according to their DAS28-CRP scores showed’high disease activity’ according to their DAS28-ESR scores.(4) The difference between DAS28-CRP and DAS28-ESR is much larger in females (0.59±0.43) than that in males (0.24±0.45), with significant statistical difference (P<0.05).(5) The difference between DAS28-CRP and DAS28-ESR is not related to age, disease duration.ConclusionsWhen assessing disease activity of patients with RA, there is different between DAS28-CRP and DAS28-ESR. DAS28-CRP is lower than DAS28-ESR, especially in females. The difference between DAS28-CRP and DAS28-ESR is not related to age, disease duration. |
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