on my blog post 'Hopeful' Clucky from NRAS recommended that next time I see my Rheumy I ask what my DAS is and referred me to the information on DAS on the NRAS website. I've had a look at that & it's raised a few questions.
The CEO of NRAS says at the beginning of the info. vid on DAS that NICE guidelines now recommend that those newly diagnosed with RA should be monitored monthly in order to assess whether their treatment is working. Has anyone here been monitored on a monthly basis?
The focus on RA begs the question of whether those of us who are diagnosed with other forms of inflammatory arthritis, or like me, simply with 'sero-negative inflammatory arthritis', should also be monitored on a monthly basis according to the NICE guidelines and, of course, whether DAS applies only or predominantly to RA.
The DAS examination process is shown in the video and does not resemble any examination I've been given. In the 2 Rheumy consultations I've had so far the physical examination was nowhere near as rigorous.
I know that the DAS is much criticised and I'm beginning to understand why.
Even if I were to have the physical examination shown, I doubt very much that it would reflect what is happening to my body. My knees would be DAS stars - swollen, hot, bingo! Other joints complain constantly but are not very swollen and are not tender to the touch. For example my right little finger hurts when it rests on a hard surface so writing is difficult, but for some reason manipulation or pressing doesn't hurt. It would seem that DAS doesn't kick in until joints are very obviously in big trouble; too late, potentially, to prevent damage. I have a lot of pain in my feet, too, but they don't count for DAS purposes. Why not?
I think that I could easily end up needing to use a wheelchair without ever having had a shot at Biologics if DAS is the main criteria for prescribing them.
The DAS examination seems to rely purely on a physical examination, ESR and the patient's own assessment of their condition. I can't help wondering how much weight is really given to patient input. I know enough about other peoples' experiences of inflammatory arthritis to know that not everyone has raised ESR when they feel that their disease is at its most active, nor do they necessarily have visible or pronounced swelling.
There seem to be 2 very noticeable omissions from the DAS process: the Rheumy's clinical judgement and technical input from x-rays or MRI etc.
I'm in two minds here! On the one hand I agree with Clucky, good idea to try to find out what my DAS score is, if only to get a thorough examination, perhaps. On the other hand, I'm pretty sure it would show that I'm not too bad at all, thanks very much which, sadly, is rubbish.
Look forward to hearing what people think or know about DAS, I expect I've over-simplified or got some things wrong, too.
PS while I was writing this my OH was inspired to actually have a look at the NICE guidelines which is the next thing I need to do. He reckons they specify that someone like me should be on at least one other drug in addition to MTX. Are the NICE guidelines worth the paper they are written on or are they, to use an annoying business buzzword, 'aspirational'?