Why don't feet count re the DAS score?

I can't see how feet shouldn't count - can't understand it at all because we need to walk? Having had mine badly affected prior to MTX I can see why hands are incredibly important to us all but why are some joints more crucial than others to the DAS score? Baffled entirely - this surely needs changing?

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Couldn't agree more Tilda. Especially as we have to have our hands and feet x-rayed before treatment begins to ascertain whether damage has already occurred.My consultant examined my feet too on the initial appointment, so it's very strange that they seem to be ignored from that point on!

I agree, something should be done to change this, but somehow I can't see it happening anytime soon!!

Carolyn x

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Yes it's blatantly daft isn't it Carolyn! Nice to put a face to the name too. Tilda x

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This has always exasperated me too Tilda, particularly as RA generally first manifests itself in hands and feet. It seems a bit like cheating to me!.

Judy

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Me too, its crazy and i don't know why either.

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ok i did a bit of research and got this from another arthritis site in answer to the same question. Apparently it came from a rheummy consultant:

'The joints below the knee were excluded because they were difficult to assess using the DAS pressure technique and the overall accuracy and reproducibility of the individual's score was not affected by omitting them when the DAS was being developed'

[helixhelix]

What I was told is that feet weren't included as they don't swell in the same way as other joints, so more difficult to distinguish between tender and swollen joints.

From the things I've read the jury's out as to whether it makes any difference. Some papers seem to say that if DAS is just being used to measure the ebb & flow of your RA then doesn't really matter how many joints you measure. But others say that it is important, especially for example if you're deciding whether or not someone's in remission or not based on it. so who knows. But I find it frustrating, especially as my feet are dreadful compared to the rest of me. Px

[collette]

I couldn't agree more. I was thinking exactly the same thing today when I read a post about DAS and researched to see what it was. I also wondered why ankles are not included as my ankles swell and hurt as well as my feet.

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I get checked equally for my feet and my hands each time (3 times so far) and my rheumy seems just as concerned about them as my hands. But I do get annoyed because some of my swelling is in my tendons but that doesn't seem to count either and yet my physio and research both tell me that it's clearly due to RA?

Also, as I've said here several times before, I don't think inflammation shows up on all of us visibly or even with examination - certainly I have a raised/ high ESR a lot of the time but very little visible inflammation. I think my GP has only seen my hands really swollen once and he nearly jumped when he spotted them exclaiming "oh gosh your hands are really swollen!". I've never had an ultrasound scan on my joints and that annoys me too because I'd like them to be more thorough before pronouncing "not inflamed" during examination.

How can they pronounce that "the overall accuracy and reproducibility" of someone's score is not affected if the person suffers most of all in their feet? How bonkers is that as an argument? It sounds very unscientific to me. I'm starting to be rather glad that my rheumy doesn't seem to work to the DAS scoring protocol actually - or if he does at least I'm not aware of it! Tilda x

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Excluding one very commonly affected area of the body from the criteria which can be used to decide whether a person gets even more expensive treatment .... anyone would think that it's a nifty way of saving money!

(Am not 101% sure what DAS is, so may have got wrong end of stick!)

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You've got the entirely right end of stick Feather. It's appalling! And the DAS = disease activity score. Tilda xx

[Ozzy]

My joints on my hands are very swollen, I also have a lot of pain in my feet, elbows etc. But my ESR is 11 as high as it has ever been. I have sero negitive RA but after trying four different drmds I am on Hurmira, so I think that maybe I got the drugs because of having beautiful sausage fingers all the time, they have never reduced in size, the swelling just spreads further up my fingers.

[Hidden]

Hello,

As I read this I remember Lyn blogging about this, here's what she said about feet....

'I often wondered about why feet were not included in the assessment. In my case it was my feet that were the first to show significant joint damage and subsequent surgery to remove badly damaged metatarsal heads. Due to the damage they are often more painful than other bits. I am assured however that this is due to joint damage and not, for the main part, ongoing disease activity. It was stressed that the feet are most likely to 'feel bad' because they're in constant use and most RA sufferers will have painful feet. By including everyone's feet would simply mean altering the levels of the scores. Seems reasonable!

ahhhh, Lyn was more informative than any Consultant!

She's written a great blog on DAS, if anyone's interested.

Hope your having fun and that yourself and Cathy behaved yourselves the other night, we have sunshine!!! xx

[Hidden]

Am in the middle of Glasgow right now - where the sun is trying to come out at least! Yes I recall reading this by Lyn - I suppose its right to start with feet although mine are okay (apart from when I'm tramping about a city with 2 tall menfolk! I still think some suffer properly in feet where others like me have damage to hands and I think both are fundamental to quality of life. But as its the experts who diagnose I guess they know best how to monitor disease activity.Seeing Cathie tonight. Tilda xx

[KaysDad]

I know this is an old post but this issue does keep returning. It is frustrating and we are continually told that it is difficult or time consuming to do and anyway there is a high correlation between the full DAS and the "no feet" DAS but, if that is so, explain why is this still an issue? The DAS is used to determine eligibility to certain drug treatments so, for people like us, most joints can be fine but the feet are painful, either all the time or, like me, when I walk. Therefore, if your only pain is in your feet, you are deemed to be in remission and not in need of any further treatment!

[Hidden in reply to KaysDad]

It’s just so stupid especially when you go to your first consultation they ask how long your feet are stiff for in the morning and the first sign of RD is stiff feet

[JFlay in reply to Hidden]

Totally agree, my feet are the worst part of it 😞