DISEASE ACTIVITY SCORING IN

RHEUMATOLOGY
 CONTENTS
1. RHEUMATOID ARTHRITIS
a. DAS 28
b. CDAI
c. SDAI
d. ACR response

2. JUVENILE ARTHRITIS
a. JADAS

3. PSORIATIC ARTHRITIS
a. DAPSA
b. MDA
c. PSARC

4. ANKYLOSING SPONDYLITIS
a. BASDAI
b. BASFI
c. ASDAS
d. ASAS

5. SYSTEMIC LUPUS ERYTHEMATOSUS

a. SLEDAI
RHEUMATOID ARTHRITIS
 DAS 28
• Assessment of the total 28 joints.

• Both Left & Right side:

Shoulder (2), Elbow (2), Wrist (2), MCP (10), PIP (10), Knees (2)

REQUIREMENTS:

• SJC= Swollen Joint Count (Number out of 28)

• TJC= Tender Joint Count (Number out of 28)
• ESR or CRP values.
• Global Health Visual Analog (GH) (0-100mm)
 DAS 28 INTERPRETATION
FORMULA:

• DAS 28 = 0.56 √ (TJC28) + 0.28 √ (SJC28) + 0.70 ln(ESR) + 0.014 GH

• DAS28-CRP = 0.56 √ (TJC28) + 0.28 √ (SJC28) + 0.36 ln(CRP+1) + 0.014GH + 0.96

Values:

High Disease Activity > 5.1

Low Activity < 3.2
Remission < 2.6

ONLINE CALCULATOR: http://www.das-score.nl/

CDAI (Clinical Disease Activity Index)

Aletaha & Smolen . Clin Exp Rheumatol 2005; 23 (Suppl. 39):S100-S108.

SDAI (Simple Disease Activity Index)

Aletaha & Smolen . Clin Exp Rheumatol 2005; 23 (Suppl. 39):S100-S108.

 ACR Responses
ACR 20; 50; 70 responses ACR REMISSION CRITERIA

An improvement to 20%, 50%, 70% levels in ≥ 5 of the following present at least for 2
parameters outlined, require improvements in consecutive months.
both SJC, TJC & 3 out of 5 other items:-

SJC Morning stiffness ≤ 15 minutes

TJC No fatigue
Pain VAS No joint tenderness or pain on motion
PGA No soft tissue swelling in joints or tendon
sheaths
ESR or CRP ESR ≤ 30mm/h for Females OR 20 mm/h for
Males
Functional Questionnaire (HAQ)

Ranganath VK, et al. Clin Exp Rheumatol. 2006 Nov-Dec;24(6 Suppl 43):S-14-21.
 Summary of RA scores
Although PAS, PAS-II, RAPID-3 are also validated in RA;

BUT

DAS 28, CDAI, SDAI………these 3 are only highly recommended by ACR, as due to :-

a. RELIABILITY
b. VALIDITY
c. RESPONSIVENESS

• SDAI & DAS 28 requires formal joint counts and lab test; CDAI requires only formal
joint counts

Anderson J, et al. Arthritis care & research. 2012;64(5):640-647.

JUVENILE ARTHRITIS
 JADAS
The JADAS requires the following 4 measures: -

A. Physician’s global assessment of disease activity,

measured on 0–10 visual analog scale (VAS); where 0 = no
activity and 10 = maximum activity.

B. Parent global assessment of well-being, measured on 0-

10 VAS where 0 = very well and 10 = very poor.

C. ESR normalized to a 0 to 10 scale.

D. Joint counts with active disease.

Cervical spine, Elbows, Wrists, MCP

joint, PIP joints, Hips, Knees, Ankles.
 JADAS INTERPRETATION
Formula = Linear Sum of the scores of its 4 components ; (Ranges are 0–101 for JADAS-71,
0–57 for JADAS-27, and 0– 40 for JADAS-10)

JADAS 10/71 JADAS 27

OLIGOARTHRITIS
Inactive disease activity ≤1 ≤1
Low disease activity 1.1 - 2 1.1 - 2
Moderate disease activity 2.1 – 4.2 2.1 – 4.2
High disease activity > 4.2 > 4.2
POLYARTHRITIS
Inactive disease activity ≤1 ≤1
Low disease activity 1.1 – 1.38 1.1 – 1.38
Moderate disease activity 3.9 – 10.5 3.9 – 8.5
Consolaro A, et al. Ped Rheum On Jour.
High disease activty > 10.5 > 8.5 2016;14:23.
PSORIATIC ARTHRITIS
DAPSA
REQUIREMENTS:-

1. TJC 2. SJC 3. CRP 4. Activity 5. Pain

DAPSA = TJC + SJC + CRP + Activity + Pain

Disease activity:-
0-4 Remission, 5-14 Low, 15-28 Moderate, > 28
High disease activity.
MDA (Minimal Disease Activity) Assessment
PSARC (Psoriatic Arthritis Response Criteria)
ANKYLOSING SPONDYLITIS
BASDAI

TOTAL OF (1+4) ADDED TO THE

MEAN OF (5 & 6) = TOTAL OUT
OF 50

Then, TOTAL / 5 = BASDAI SCORE

A cut off of 4 signifies Active

Disease, but it does not has
any firm justifications.
BASFI

Total Sum is divided by

10 to get BASFI Value
 ASDAS
0.12 x Back Pain + 0.06 x Duration of Morning Stiffness + 0.11 x Patient Global + 0.07 x
ASDAS-CRP
Peripheral Pain/Swelling + 0.58 x (Log of CRP+1)
0.08 x Back Pain + 0.07 x Duration of Morning Stiffness + 0.11 x Patient Global + 0.09 x
ASDAS-ESR
Peripheral Pain/Swelling + 0.29 x √(ESR)

Back pain How would you describe the overall level of AS neck, back or hip pain you have had?
NONE 0 1 2 3 4 5 6 7 8 9 10 VERY SEVERE

Duration of morning stiffness How long does your morning stiffness last from the time you wake up?
0 1 2 3 4 5 6 7 8 9 10
________________________________________ __
hrs ½ 1 1½ 2 or more hours

Patient global How active was your spondylitis on average during the last week?
NONE 0 1 2 3 4 5 6 7 8 9 10 VERY SEVERE

Peripheral pain/swelling How would you describe the overall level of pain/swelling in joints other than neck, back,
hips you have had?
NONE 0 1 2 3 4 5 6 7 8 9 10 VERY SEVERE
 ASDAS INTERPRETATION
ASDAS value :-

less than1.3 is considered low disease activity

between 1.3 and 2.1 as moderate disease activity
between 2.1 and 3.5 as high disease activity
above 3.5 as very high disease activity

Machado P, et al. Ann Rheum Dis. 2011;70(1):47–53

 ASAS
• ASAS 20 is defined as an improvement of at least 20% and an absolute improvement of
at least 10 units on a 0-100 scale in at least 3 of the following domains:
Patient global assessment, Pain assessment, BASFI, and Inflammation (last 2 questions
of BASDAI).

• ASAS 40, 50 and 70 are defined as above with improvements of at least 40%, 50% and
70% respectively.
SYSTEMIC LUPUS ERYTHEMATOSUS
SLEDAI
SLEDAI…….continued
SLEDAI…….continued
SLEDAI…….continued
THANK YOU