Disease Activity Score (DAS)

Hi. Rheumatologist use a DAS to assess the activity of the RA. It adds up a number of swollen and tender joints and comes out with a score. Oddly, though, they do not include feet and ankles in the assessment. Why is this? Many sufferers have the most problems with these areas so I'm intrigued. Sometimes if I go I would come out as having no active disease because they don't count those joints. I didn't even know the nurse specialist was doing this assessment until I asked her and she said all the professionals do it. Any thoughts on why no feet/ankles? Thanks

15 Replies

  • There used to be a DAS 44 which included far more joints (including feet) but research showed it didn't provide more of an accurate guide to how you are doing than the DAS 28 (no feet) that's used now. Also feet can be tricky as don't show swelling in same way, and have many non-RA related problems. So no feet now..... which is all well and fine unless you happen to be one of the many with dreadful foot problems!

    But I just witter on so much about my feet that they do pay attention to them now, even if not as part of my DAS score.

  • Thank you! V. Annoying but at leat I know the rationale now x

  • Couldn't have said it better myself Helixhelix. Very well explained! :)

  • I asked my nurse this question and she said if you have it in your hands your feet will be the same my das sore is 5.50

  • Are you not eligible for biologics June been?

  • I keep asking asking but they want to go back to mtx and I have said no four failed drugs so far go back after Christmas now

  • Sounds like you need something. Good luck hope you get sorted. A lot time to be swollen and in pain.

  • I wonder if that is why my rheumatologist always asks about my feet. I thought he had some kind of obsession!

  • A lady called Lyn posted awhile ago about it


  • It's a you know what for many of us. I was diagnosed in 2008 in Spain where they still do the DAS 44 (or did, we came back in 2012). I'm similar, my most problematic joints are my feet - toes & ankles & they've never been in such a state since returning because my Rheumy insisted as they weren't included in the DAS 28. I was confused because I wasn't aware they didn't do the 44 exam here & was then concerned about my neck as that's not included either but she would examine that! The excuse she gave about feet was that many other things could cause issues but surely if that's the most affected joint(s) then a little leeway should be given, at least not ignored? It was my feet where RD was first detected, the reason I went to my GP in the first place & each Consultant paid specific attention to them & meds adjusted as they determined. As such they were no bother except for the odd niggle which was addressed at my next appointment. Through neglect I now have multiple problems, I've over pronation as my arches are shot, 2 hammer toes (the others are clawed) & daylight sign, metatarsalgia, multiple corns on what were previously the balls of my feet though I've lost the fatty pads but the constant swelling above my toes makes up for that.... & more. Eventually they were examined, apologies given & my meds amended as I had disease activity (no sh1t Sherlock!!!) but 2 years too late & despite them being mentioned at each appointment, including nurses appointments. For over a year now I see Podietry regularly & have custom made insoles but I'd rather have nicer, less painful feet! Grrr, sorry gone off on one, I'm sure I'm not alone, you probably have worse damage. Like you without the VAS score I'd have been considered to be in remission many a time, in fact my latest DAS score was 3.1, my feet say different, or would if they were included!

  • My Nurse never looked at my joints last visit. As foe DASH score over a year ago and it was 5.3.

  • Did she give any reason moomie? Seems to me as you'd active disease it should really have been performed.

  • No she wanted to show a Dr the photo of my toe nails. Discouured pitting and the new add on disease. Tried to tell her about joints but time up.

    Did get appointment at injection clinic though.

  • Ah, well I s'pose that's a good reason but a quick check of your most bothersome ones wouldn't have put her out even if she didn't do the DAS.

  • Oops no glasses on again lol. Sorry dash now that is good :)

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