Disease Activity Score-28 Values Differ Considerably Depending on Patient's Pain Perception and Sex

BURKHARD F. LEEB, PIA M. HAINDL, ADIL MAKTARI, THOMAS NOTHNAGL, and BERNHARD RINTELEN

ABSTRACT.

Objective. To determine if the Disease Activity Index including a 28-joint count (DAS28) is equally applicable for the total population with rheumatoid arthritis (RA).

Methods. Five hundred fifty-seven outpatients with RA [432 women, 125 men; median age 64 yrs (range 0–85), median disease duration 48 mo (range 2–548)] were enrolled consecutively into this cross-sectional study. DAS28, physician's global assessment of disease activity, patient's assessment of pain on visual analog scale, C-reactive protein (mg/dl), rheumatoid factor (RF), and disease duration were recorded. t-tests were applied for all comparisons of DAS28 values. Linear regression analysis was performed for each confounding factor.

Results. The mean DAS28 in female patients was 3.66 ± 0.57 SEM, and in males 3.01 ± 1.12 (p < 0.001). DAS values in patients with early RA (< 37 mo) were significantly higher than in patients with advanced RA (3.62 ± 0.67 vs 3.37 ± 0.81, respectively; p < 0.017). Regression analysis revealed a highly significant relationship between DAS28 score and patient's pain rating (r = 0.592, p < 0.0001). Pain exerted the greatest influence on the DAS28 (p < 0.0001), while of the other factors only age (p < 0.008 for females, p < 0.007 for males) was also significantly correlated with the DAS28 values.

Conclusion. DAS28 values differ considerably depending primarily on the patient's pain perception and gender and to a lesser degree on patient's age, whereas results for disease duration and RF were inconclusive. (First Release Nov 1 2007; J Rheumatol 2007;34:2382-7)

Key Indexing Terms:

RHEUMATOID ARTHRITIS
PAIN
GENDER
DISEASE ACTIVITY ASSESSMENT

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From 1st and 2nd Department of Medicine, Center for Rheumatology, Lower Austria; State Hospital Korneuburg-Stockerau; Karl Landsteiner Institute for Clinical Rheumatology; A-2000 Stockerau, Landstrasse 18, Austria

B.F. Leeb, MD; P.M. Haindl, MD; A. Maktari, MD; T. Nothnagl, MD; B. Rintelen, MD, 2nd Department of Medicine, Center for Rheumatology, State Hospital Korneuburg-Stockerau, Karl Landsteiner Institute for Clinical Rheumatology.

Address reprint requests to Dr. B.F. Leeb, Humanisklinikum NÖ, 2nd Department of Medicine, Lower Austrian Center for Rheumatology, Landstrasse 18, Stockerau A-2000, Austria. E-mail: leeb.humanis@kav-kost.at

Accepted for publication August 30, 2007.

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