Please could someone tell me if the DAS criteria has changed? After reading another post this morning I looked up some calculators, but they don't seem to include the feet anymore. Am I missing something? My ankles and toes are really playing up today, however, when my biologics nurse did my DAS week before last she wasn't interested in my feet at all and I wondered if this affected my score (as I had come down to 4.2 from 5.9 the previous week, when my feet were included), thus affecting my biologics eligibility.
Good Friday Everyone! DAS: Please could someone tell me... - NRAS
Good Friday Everyone! DAS
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Diamondpainting
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I thought that they never were included from previous posts but no idea why. Sorry.
Oh ok - maybe I have it all wrong (no change there
😂). Thank you for replying!
I was told years ago they weren’t included and was very concerned then to hear that and still am! The rheumy said it’s hard to do when nearly everyone has issues with their feet. I just don’t like DAS and never have! 🤨😑😫🤬
I recall thats what was said to me but it wasn't a problem as I saw an Orthopaedic Surgeon who operated on my foot. I might have been lucky but my feet have never been a problem since and I wear normal shoes with no need for the awful insoles. I think a lot are fobbed off and it is an awful problem if feet are painful with or without having RA.
My RA started in my feet so it’s always been an issue on and off. When I was told they don’t matter to our DAS, I felt like saying .. you have these feet then! My feet/toes look very decent, actually but when I try curl my toes the two middle ones won’t do it properly which was where it all started. Despite being an athlete I always had flat feet so that exacerbated with the RA when I lost muscle and fat under the ball of foot. They’re ok at the moment. Just one bridge of foot and ankle swells on extreme heat every summer.
Funny how RA is so different I just had a sore finger on my right hand. GP did a blood test and bingo positive for RA. I was treated aggressively from the start and I think its why I have almost no damage just a bit of occasional right hand knuckle swelling. Of course my left foot was straightened but that put it back to normal. I'd had Mortons Nuromas on my left foot too and that may well have been prior to the hand and they were removed twice to relieve pain. I'd like to know why the feet aren't included as it affects so many people it doesn't seem right. I wonder if its a case of the NHS does the cheapest option and puts off things until the person is desperate. I had insurance and the consultant said ignore podiatrist , surgery is best option and works. I was angry as I believed the podiatrist with insoles even though they made the problem worse. Consultant told me why it was because the insole put pressure on the Nuroma not good. ! Only time pain has made me cry it was so bad.
I have flat feet as well. They have always been a problem but more so now.
Comfortable supportive footwear makes a huge difference but I still can feel like I’m walking on stones in bare feet.
My feet are where a lot of my pain is - plus on one foot, if I try and bend the toes they don't bend at all but just splay, and the other foot my two smaller toes have started crossing over. I do have OA in my big toe joints, but nothing has been done about them and I have orthotic insoles. I get really upset when shopping for shoes because the insoles only seem to fit in a certain style - which to me look clumpy and old fashioned. I have burst into tears in a shoe shop before, much to the consternation of the poor sales assistant!
I have given up on a lot of shoe styles but find there are styles and brands which are still fashionable I can wear. I never liked very high shoes or ultra flat ballet slipper styles so I’m not too sad to miss out on those, Anything too high or too low is no good.
Unfortunately, I don't think feet have ever been included in the DAS28 scoring system. I think there are other scoring systems used in Europe and the US which do include feet.
I agree with you that when feet are a big problem they are still often ignored, as I well know! I insist on my feet being considered by my rheumatology team because they affect considerably my mobility. I suggest take photos if they trouble you at the moment and attach them to an email to the rheumy nurse/patient helpline/consultant with a detailed explanation of the problem.
It's a significant issue for many of us and the NRAS website has a special section dealing with feet issues. nras.org.uk/resource/ra-foo...
There was also an excellent webinar recently but I can't find it on the NRAS site. Here's a link to one recorded in 2019. nras.org.uk/resource/webina...
I hope you manage to get someone to take notice of your problems.
If I could I’d jump up and down about feet and DAS. I’d only make my feet worse so I won’t! 🤨
Thank you Lolabridge. Funnily enough I did take some photos of my feet - I have never done that before. I wonder why they are not counted especially as for many people this is where their RA journey begins. I must have seen the foot chart on a non UK site.
Oh ……. This frustrates me . Feet are not included in the DAS score which is unbelievable for so many people this is where their RA started me included and is still my most effected joints .
My rheumy always says all joints so I include my feet. Probably now on biologics on false pretences 😂
Sensible rheumy re all joints.
As far as I can remember in 14 yrs of having RA they've never looked at my feet - just my hands.
My Rheumatologist looked at my feet on my first visit, he said I had fluid retention which I hadn’t noticed. I’m having very bad problems with my feet right now, thinking it’s some kind of neuropathy. Hoping to speak to my GP again this afternoon as it’s becoming unbearable.
I've had fluid retention in my feet for years- especially in hot weather. I was told it was the BP meds I'm on but as they work well I'm not too concerned. Hope you manage to get sorted soon xx
Yes I was told the fluid retention was due to BP meds. too. Thank you for your kind words MadBunny. 🙂
You're welcome xx
Mine looked at my feet first visit too. Hope they figure out your neuropathy.
I think we were lucky smilelines, I don’t understand why it isn’t the same for everyone. Thank you for your good wishes, all the best to you.
Never had my feet included, that I remember,in my DAS score in 30 years.I wish they were.
There used to be DAS 44, which included feet. However when people’s treatment using DAS 28 and DAS 44 were compared it seemed that it made no difference to treatment plans and long terms outcomes. So was judged not to be worth the extra effort. And it’s much easy to make mistakes with feet as don’t swell in the same way and have so many other issues. (This was a long time back!)
Of course having our feet included would make us feel better!
But my rheumy looks at my feet if I mention them. And have a podiatrist appointments when I need to. So
Feet have been excluded from DAS scores for a long time…I also believe if three different clinicians examined a patient…it’s quite likely you’d get three different scores.
The DAS score never did include the feet because there are too many bones in the foot it would be impossible to do. That is what I was told by my rheumy nurse.
Yes and I was even told by onethere isn’t a diagram/form big enough showing the feet/toes for us to complete. I said ../ I’m an artist I’ll draw you one!
😂😂😂
Excuse my ignorance but I have no idea of DAS score, I just answer questions from my rheumatology and have just started COSENTYX (biologic). Are you suggesting if the DAS score goes down - ie medication works you might become ineligible for biologic?
Its partly the DAS score that opens up advanced medication to us, if working for you and swelling in your joints reduce you would not be taken off it as the purpose of medication is a reduction in joint activity.
Well I thought NRAS had helped to make biologics more accessible for those with moderate to severe RA who didn’t fit the criteria before ?? If you ask me the DAS score should be scrapped. My hands have never been my major problem until the last 3 years my hands have been normal apart from zero grip. My feet, shoulders, neck, hips, knees wrists etc are another thing entirely but if the consultants just went with mainly hand issues and didn’t consider the overall picture I would be in serious trouble.
I always tell my nurse DAS is bonkers and she laughs!
Well I suppose there has to be some sort of recognised criteria that is generally recognised & for now the DAS is it? Imagine the mess that would arise about eligibility for certain drugs if every rheumy in every health authority had his own score board…no one would ever get more than an aspirin!
It’s the foot thing I will never think is right. I’m not denying some sort of criteria is needed but to exclude feet ....
DAS includes 28 joints, plus your blood inflammatory markers and how you say you feel. The point is that using the same approach over time is a way to asses whether you are stable, improving or regressing. It helps to guide treatment, and treating to target has been shown to be beneficial to patients.
I have been advised by my rheumatology team that feet sadly are not part of the DAS score. I was assessed for biologics this year and my feet were not included despite them being badly affected. I was fortunate that I did meet the criteria for biologics. I’m lucky that my team do always check my feet as part of my appointments even though they are not included in the DAS score as have awful problems with my feet amongst other joints. x
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