does anyone unerstand the details in my letter from the ra nurse as i said before i was taken of mtx after 4 weeks due to nausea and i am waiting to go for a scan on my hands i recieved the letter today that the ra nurse had sent my gp ... what is global vas 60, esr 17 and disease activity score 5.46? all sounds very scary to be honest .

I hope everyone here is feeling as well as they can do im finding this is the first place im turning to at the moment so thankyou ...x


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You are going to get a lot of answers to this one as you have given your results. My advice is to ask for a sit down and an explanation. Bring a good friend, parent or OH with you to listen to answers. Yep it sounds scary, I've seen worse & i've seen better but it sounds typical positive early active RA diagnosis, and as I said they may escalate your treatment & meds, which is good and means that they are paying attention, at least thats what it sounds like.

Really in your situation, you need to speak directly to a Consultant Rheumatologist, demand it, be pro active its your life.

Nobody on here can replace the experts, we are just experiencing the day to day impact of the disease on everyday life.

Kindest Regrads, Gina.

Regards, Gina

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it not a good result then ? im just waiting around for this hand scan then they will sort out the right mediations , i feel as if im left in the dark with it all im so glad i found this site thankyou


Vas is Visual assessment score. It is usually done by giving you a 10cm line and asking you to draw a line on it to show how you feel (one end of the line us the best ever and the other is the wort ever) the mark is yhen meadured in mm. Esr is an inflamation marker measured from your blood tests. Disease activity score (DAS) is calculated from Vas esr & the number of tender and swollen joints. There is information on the NRAS site about SAD but 5.46 is quite high. Hope this helps.



I've pasted in the info on blood tests from my MTX monitoring book - bit long I'm afraid but helps explain.

Hb Haemaglobin - the oxygen carrying protein pigment in the blood, and specifically in the red blood cells. Normal values 11.5-18 (low Hb can be caused by anaemia)

WBC - White blood cells. . These increase in number due to infection. Normal values 4.0-11.0

Platelets - An irregular disc shaped element in the blood that assists in blood clotting. Normal values 150-400

Lymphocytes - A small white blood cell that plays a large role in defending the body against disease. They are responsible for immune responses. Normal values 1.0-3.0

Neutrophils - type of white blood cell filled with enzymes used to kill and digest micro-organisms. Normal values 2.0-7.0

ALT- (Alanine transaminase) An enzyme normally present in the liver and heart cells that is released into the bloodstream when the liver or heart is damaged. Rising ALT levels may indicate liver damage. Normal values 7-56

AST - (Aspartate aminotransferase) measures the amount of this enzyme in the blood. AST is normally found in red blood cells, liver, heart, muscle tissue, pancreas, and kidneys. Low levels are found in the blood. When an organ such as the liver is diseased or damaged, additional AST is released into the bloodstream increasing the levels. Normal values7-40

ALK Phos - An enzyme made in the liver which which is usually released into the blood during injury. The enzyme is related to the bile ducts; often increased when they are blocked. Abnormally high levels may indicate liver damage. Some RA patients have high levels due to inflammation. Normal values 30-125

CRP - C-Reactive Protein. A plasma protein that rises in the blood with the inflammation of RA. Normal values <6

ESR - Erythrocyte Sedimentation Rate. A blood test that detects and monitors inflammation in the body. The rate increases with more inflammation. Normal values 1-7 (but can vary with individuals, some people go way up)

Other tests that can be used to assess liver function include gamma-glutamyl transferase (GGT) and Total bilirubin – measures all the yellow bilirubin pigment in the blood. Another test, direct bilirubin, measures a form made in the liver and is often requested with total bilirubin in infants with jaundice. Albumin – measures the main protein made by the liver and tells how well the liver is making this protein. Total protein - measures albumin and all other proteins in blood, including antibodies made to help fight off infections


thankyou so much for the reply helped alot ..x hope your feeling well today


Hi Sharon,

In Laymans terms the ESR (dont know what it stands for off the top of my head) but it registers how much inflamation is occurring within you = The more inflamation, the more swollen/stiff your joints might be (and you might not be feeling too great orgetting over a cold or something :P )

Your ESR is 17 and 10 or less is 'normal' got that from here:

When I was first diagnosed I had an ESR reading of 3 - but walking was extremely painful and couldnt raise my arms or use my hands properly so I think this reading might not be intirely indicative of RA activity?

The D.A.S is your Disease Activity Score.Bbasically the nurse or Consultant will count the specific areas that are swelling, finger joints, wrists, knees, elbows & hips. ( for some reason they dont count feet, toes, ankles, back, neck or jaw) They then count the specific areas that feel sore or tender to you - usually the same areas that are swollen but there might be areas that are not swollen that hurt.

Then they will ask you to rate how wretched or well you feel out of 100.

The result of the above questions will give you a Disease Activity Score which in your case is 5.46. (your possibly not feeling too good at the moment *hugs* )

One of the posters here located an online version of this test so as long as you know what your latest ESR is (it goe up and down) it can help you track inbetween consultant appointments.

Its here:

Hope that helps!

Take care



This really helped it all seems like double dutch when i read the letter the net doctor site looks a good site to thankyou so much for the reply hope your feeling well today ...x


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