Editing Rheumatoid arthritis (section)

===Monitoring progression===

Many tools can be used to monitor remission in rheumatoid arthritis.
* DAS28: ''Disease Activity Score of 28 joints'' ({{visible anchor|DAS28}}) is widely used as an indicator of RA disease activity and response to treatment. Joints included are ([[bilateral symmetry|bilaterally]]): [[proximal interphalangeal joint]]s (10 joints), [[metacarpophalangeal joint]]s (10), [[wrist]]s (2), [[elbow]]s (2), [[shoulder]]s (2) and [[knee]]s (2). When looking at these joints, both the number of joints with tenderness upon touching (TEN28) and swelling (SW28) are counted. The [[erythrocyte sedimentation rate]] (ESR) is measured and the affected person makes a subjective assessment (SA) of disease activity during the preceding 7 days on a scale between 0 and 100, where 0 is "no activity" and 100 is "highest activity possible". With these parameters, DAS28 is calculated as:<ref name=Prevoo1995/>
<math>DAS28=0.56 \times \sqrt{TEN28} + 0.28 \times \sqrt{SW28} + 0.70 \times \ln(ESR) + 0.014 \times SA</math>

From this, the disease activity of the affected person can be classified as follows:<ref name=Prevoo1995>{{cite journal | vauthors = Prevoo ML, van 't Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL | title = Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis | journal = Arthritis and Rheumatism | volume = 38 | issue = 1 | pages = 44–48 | date = January 1995 | pmid = 7818570 | doi = 10.1002/art.1780380107 | url = http://www.pharmacoeconomics.ru/jour/article/view/135 | hdl = 2066/20651 | s2cid = 11192145 | hdl-access = free }}{{subscription required}}</ref>
{|class="wikitable"
|-
!colspan=2 rowspan=2| Current <br>DAS28 !!colspan=3| DAS28 decrease from initial value
|-
| [[more than|>]] 1.2 || > 0.6 but [[less than or equal to|≤]] 1.2 || ≤ 0.6
|-
| [[less than or equal to|≤]] 3.2 || Inactive || Good improvement || Moderate improvement || No improvement
|-
| [[more than|>]] 3.2 but ≤ 5.1 || Moderate || Moderate improvement || Moderate improvement || No improvement
|-
| > 5.1 || Very active || Moderate improvement || No improvement || No improvement
|}

It is not always a reliable indicator of treatment effect.<ref>Kelly, Janis (22 February 2005) [http://www.medscape.com/viewarticle/538134 DAS28 not always a reliable indicator of treatment effect in RA] {{webarchive|url=https://web.archive.org/web/20110225054141/http://www.medscape.com/viewarticle/538134 |date=2011-02-25 }}, Medscape Medical News.</ref> One major limitation is that low-grade synovitis may be missed.<ref>{{cite journal | vauthors= Uribe L, Cerón C, Amariles P, Llano JF, Restrepo M, Montoya N, González LA, Díaz OJ, Saldarriaga MA, Gómez-Puerta JA |date=July–September 2016 |title=Correlación entre la actividad clínica por DAS-28 y ecografía en pacientes con artritis reumatoide |trans-title=Correlation between clinical activity measured by DAS-28 and ultrasound in patients with rheumatoid arthritis |journal=Revista Colombiana de Reumatología |volume=23 |issue=3 |pages=159–169 |language=es |doi=10.1016/j.rcreu.2016.05.002 }}</ref>
* Other: Other tools to monitor remission in rheumatoid arthritis are: ACR-EULAR Provisional Definition of Remission of Rheumatoid arthritis, Simplified Disease Activity Index and Clinical Disease Activity Index.<ref>{{cite journal | vauthors = Yazici Y, Simsek I | title = Tools for monitoring remission in rheumatoid arthritis: any will do, let's just pick one and start measuring | journal = Arthritis Research & Therapy | volume = 15 | issue = 1 | pages = 104 | date = January 2013 | pmid = 23374997 | pmc = 3672754 | doi = 10.1186/ar4139 | doi-access = free }}{{subscription required}}</ref> Some scores do not require input from a healthcare professional and allow self-monitoring by the person, like HAQ-DI.<ref>{{cite journal | vauthors = Bruce B, Fries JF | title = The Stanford Health Assessment Questionnaire: dimensions and practical applications | journal = Health and Quality of Life Outcomes | volume = 1 | pages = 20 | date = June 2003 | pmid = 12831398 | pmc = 165587 | doi = 10.1186/1477-7525-1-20 | doi-access = free }}{{subscription required}}</ref>{{page needed|date=July 2017}}