DAS score - why don't they include ankles & feet?

I was wondering why feet & ankles weren't included in the DAS scoring? Seems strange to me!

[Hidden]

I've often wondered this myself Pauline. After all, pain and stiffness in ankles and feet is also one of the typical signs of RA. Hope someone can answer this for both of us. x

[kizzy12]

when i asked they said it was because everyone with ra has problems with their feet and ankles so not worth including..they need to see what is flaring abnormally...really daft as far as i'm concerned!!

[EmmaS-NRAS NRAS]

Hi PaulineS,

A very common question and the answer below comes from the 'Patient Guide to the DAS Score' that can be found on the NRAS website here: nras.org.uk/patients

DAS28 and the feet

The joints in your feet are not included in the assessment for DAS28. This is because any inflammation or joint damage in the feet may be a chronic effect of RA, which could occur because your feet are in constant use, and not related to ongoing disease activity. Joints in the hands are therefore seen as a more reliable way of tracking your RA and seeing how well controlled your disease is.

If your RA does affect your feet, you should inform your healthcare professional so that your feet can be looked at within your consultation.

Hope that helps.

Kind regards

Emma

NRAS Membership Supervisor

[Hidden in reply to EmmaS-NRAS]

Thank you!

[Hidden in reply to EmmaS-NRAS]

Hi Emma, I must admit, I don't understand the thinking behind this. I have always had very little RA activity in my hands. For me, looking at my hands is not reliable. Not everyone with RA experiences symptoms in their hands and I think many rheumatologists are missing the point by spending (in my experience) 95% of examination time looking at the small hand joints.

I understand that we load our feet and therefore, we will see damage in weight bearing joints BUT as a young person, I resented the implication from some medical professionals that I should expect wear and tear - independently of my RA. I have a foot and ankle orthopaedic surgeon who agrees that 'normal' foot bones should not be damaged. Fortunately, as time has passed, my rheum and the nurses understand that I am badly affected in my feet and ankles but I am disappointed that feet are not considered as part of the overall picture for everyone.

Just my thoughts.

[petalnumber2]

Hi Pauline,

Apparently, when the Das score was first introduced it included over 40 joints and feet/ankles, knees were included, and apparently it took too long to complete. So, it was scaled down to just the top half of the body, hence Das 28 score. This is what has been explained to me by my clinical nurse.

My feet/ankles have always been the worst areas for me and they never look at them, let alone include them in the Das score. Like you I was concerned about it for a long time, I have even taken my shoes etc off before getting on his examination couch, but he still didn't look at my feet, so I've given up. However, he does ask for an X-ray on my feet from time to time and has sent my GP a letter expressing his concern about the damage in my feet/ankles.

I hope I have given you a little bit of info to anser your questions, and I hope you are not having a painful day today. June x

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Thank you! My feet & ankles are certainly beginning to suffer!

[bluetit33]

hello to all, I am amazed!!! I have had R/A for 48 years, and knew none of this, did not understand about DAS, was never told anything about any of this, all I have been doing over these 42 years of this disease, is going for monthly bloods, and understanding that the ESR rate was the marker. It is little wonder that I have not one joint in my body not badly deformed or of use.

But I am due, in November to go and see a rheumy at a hospital some 28 miles away, who has a good rep. so keeping up my spirits. keep smiling.

[Idontdoflats]

Hello All, in the States they do include your feet and ankles as part of the DAS score. If the UK included this in the DAS scoring, my RA would have probably have been identified earlier. I was told the pain in my ankles is because I wear heels and go to the gym!

Now my heels are in the shoe cemetery! Ahhh.

[NeonkittyUK]

Yes Pauline. Frustrating indeed for those of us with so much trouble in our feet. Grr. I was told the same as Petal re the DAS as I have called DAS "silly" before. I wonder if the feet were so obviously affected by RA and not just general wear and tear of walking etc. My rheumy does look at my feet even if can't be included in DAS and she always writes down about my foot problems, as she knows it is what stops me moving a out at the mo as they are very compromised .. fallen arches, under heel pain and achilles madness but management by podiatry and good shoe support helps/goes a long long way to help. My hands/wrists have been as bad as my feet so they alone qualified me for my biologics. I detest (sorry to say that word but I do!) the hard squeezing of fingers and knuckles when doing the DAS .. think I have likely had some nurses/consultants not knowing their own strength. They can see when knuckles are swollen and hurt so why do it to the ones that obviously are? The others not visibly swollen .. yes I agree they need to know how much pain but not press with all yout might on the ones which are so obviously swollen!! Anyhow back to the feet.

I have NEVER had an ankle xray .. only the full body isotope bone scan initially on diagnosis. Think I may have to ask my GP to request they do that as I am convinced I have had a fracture recently after an accident. Agree though it is very frustrating our feet are not taken into account for the assessment although as I said my Rheumy referred me immediately for physio and podiatry. Podiatry is a 6 month waiting list so I will go to that but in the meantime found an orthotics company a few miles form my house which does bio-mechanical assessments and makes all manner of orthotics. They look extremely professional on the website and they are a major supplier to the NHS so I may as well try them too. Finally, I will recommend to anyone with foot problems some wonderful trainers I got recently from Clarks. They are called Wave Trail GTX and are a D fitting lace up. Until recently I could not contemplate a D fitting as one foot was an E but my latest med have made my feet much less swollen. They have a wonderful sole/base/support on the heel. Yes, a bit pricey at £70 but worth it if they enable you to move round with much less pain.

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My rheumy is usually very gentle when he feels my joints so I usually work out which ones hurt beforehand so I can say "ouch" when he touches them!

However today they really did hurt!

He acknowledged that my feet, ankles & knees were swollen & is recommending me for biologics! So I felt it was a positive appointment.

I've also seen the Clarks New Wave trail & thought they looked good, unfortunately my local Clarks doesn't stock them so I would have to order them into the store but it might well be worth it!