Does my Disease Activity Score influence my consultan... - NRAS
Does my Disease Activity Score influence my consultants assessment and subsequent medication?
hi cal, yes incredibly though my rheum team did the das score for me earlier this year!! the first recorded time in 3 years for anti tnf medication. I PASSED the magic 5.0/5.1 barrier though was never told my second score!!. nurse said after 2nd assessment , consultant gets final decision see her in about six weeks!!, got an appointment which wasnt 2/3months a way and then she ordered different/ more bloods AND ultrasound of hands and wrists!, mm not as much swelling as I WOULD LIKE she said, she is no about face?? on diagnosis and mentioned possible connective disorder!??, interestingly enough this group of diseases arent eligcble for anti tnf treatment.
Inflammatory diseases such as ra, psa, AS and also most connective disorders receive dmards and unless your achieve above 5.0 and have the right /specific inflammatory diagnosis no anti tnf??. ,cynically says mr cost comes into all these decisions as ant tnf is bloody expensive about £12K plus a year, but if we are trying to work and contribute to economy, the so say average wage is twice this??!! full time, so surely if we can carry on working.
Im not informed enough to comment on your diagnosis so perhaps you can explain it to us? especially if in another great blog??X
Just a bit of a correction there Summer - AS and PsA actually have quite different criteria to RA for anti-tnfs. For AS you have to meet New York Criteria (radiology) for sacroiliitis, and they use the BASDAI not the DAS for scoring, plus you have to have limitations on the BASMI (spinal movements), and have failed NSAIDs (not DMARDs, which aren't appropriate for AS unless you also have significant peripheral arthritis). Also, RA has a lot more different anti-tnfs available, so if you fail one there are a lot of others still to try. AS only had two that were approved (though there might be a third coming in now), and they won't always even give you the second one if you fail the first (there are additional criteria you have to meet if you want to switch).
But you are right about trying to limit the cost - I saw a pretty scary medical journal article that was saying how many fewer people would be eligible and how much money could be saved if you change the DAS score requirement by even one point. The latest costs I have seen seem to be between £8000 and £9250 a year for it. When you do the economics though its well worth it, if it stops someone needing £3600 a year in DLA (high mobility, low care), and avoids loss of productivity in work (like me only working 4 days a week when I could be working 5 if I was physically more able, so that is around £5000 a year lost productivity), and then add in all the incidental medical costs and physio and OT aids, and stuff that wouldn't be required. I think £9000 a year is pretty cheap really when you look at it like that.
Well I do bow to your superior knowledge you are very well read medically, are you medical? it would be nice if you could share that with us x
I was trying to emphasise that specific listed named conditions namely Psa,, AS and RA are eligible for anti tnf, the das score was referring naturally to RA,! I Know nothing about the other two and dont pretend otherwise.
my point being if you have a generic title of INFLAMMATORY arthritis they can like in my case try to wriggle out of anti tnfs.. unless I am formally assigned specific title like RA like or psa oR AS
Hiya Cal, I think yes!
The DAS score is a tool that I don't believe has been around that long and it just gives a number to how much inflammation is going on in your body. You will notice your Rheumy will look at your joints, touch them and often squeeze them. The more inflamed and the more joints involved the higher you DAS score. Then they add into the mix your blood inflammation rates usually ESR or ALT. these results are collated to give an indication and give you an idea if your treatments are working or your inflammation is high. It's easy for us to say I really hurt at the moment or actually I don't feel bad today so it just puts a number on this.
If the DAS score as Summer says is high after trying DMARDS, I think it's two or three types and the DAS score is still high then the consultant would forward this assessment to the powers that be to gain permission for funding for Biological ( anti tnf) therapy .
So it's a handy tool, often you are given a book in the Rheumy dept so you can see how your treatment is going.
Hope you have startes some treatment and can't wait on your continuation of the Rheumy visit blog. Have a good day xx
It also depends on the rheumy, as I think DAS is used less in Scotland than other UK countries. I'm lucky to have a consultant that talks to me, so we also use it as a goal to get down to 2.6 which is the DAS level of remission, as well as using it to see how I'm getting on. As well as the magic English figure of 5.3 to be allowed to go for anti-TNF assessment, the fact that my DASwas dropping that much in the early stage of treatment meant that the doc was prepared to try changing meds and doses of traditional DMARDS. It can be a useful tool, but I think it's a bit crude as doesn't allow enough for individual variation. If you want to know more about it, then NRAS have good information:
nras.org.uk/about_rheumatoi...
Polly
Whoops...typing glitches, meant wasn't dropping, not was dropping!
It should influence their assessment as otherwise what's the point? And as it's a relatively simple formula it can & should be should be shared with the patient.
But it is a blunt instrument that fits some people's type of RA better than others. I'm all right Jack as my joints swell up as soon as anything is going on and my ESR usually reflects how I'm feeling quite closely. But for those whose inflammation hides & doesn't show up so immediately in swelling & raised ESR etc. it's not a good tool. And it's lousy if your feet are particularly bad too as it does not count anything that's going on in that area.
So you don't want your consultant to be overly dependant on DAS & if you know stuff is going on that cannot be seen or measured you need to shout louder than the DAS score.
Luce x
Think you summed it up well especially woolly. yes it is subjective .blunt thing, , but I SUPPOSE they need some criteria, agony doesnt cut it for the DAS score unfortunately and some rheums possess better clinical/ patient skills then others!!, enough said by me on this some what emotive topic for me x
Thanks everyone so much. I really appreciate this. My DAS is now down to 2.6 but I walk with great difficulty. My feet and ankles are still flared but hands etc. are ok now. Its a funny old game but eplains why my Rheumy was so pleased....and Im wondering why she can be so happy when Im struggling so much! Thanks again everyone, what a fabulous resource to have and what wonderful supportive folk - I feel a blog coming on lol 
HI Cal,think I am one of those people Luce talked about whose inflammation hides. At my first appointment my DAS suggested I was almost in remission! Luckily she listened to all my symptoms. I have wondered where I would stand in the future if I did need for be considered for anti tnfs , and do they take the way your particular RA presents itself into consideration and not just your DAS into consideration, hopefully.
Tracy x
Hi Tracy, Im with you on this one. Whoever I see, whenever I see them, they generally ask me where my problems currently are. I always say feet, ankles and achilles. There's an immediate loss of interest as this area doesn't score on DAS! So, while I shuffle about in agony....whats wrong? It clearly aint RA as nobody looks...It's no man's land! Luckily though, I have a podiatrist to see this week, I hope they help. I'm no fan of DAS! 
Thanks again though, intersting thread here x
