Disease activity score (DAS)

Starburst Member Posts: 2,546
Hi all @ the helpline team,

I have a question regarding DAS that I'm wondering if you may have the answer. DAS doesn't include the feet or ankles and no one can explain to me exactly why. I have quite bad swelling in my feet and ankles and this is where I get my worst pain. (MRI scans have confirmed inflammation.) My foot and ankle orthopaedic surgeon suggested this may be because there are so many bones in the foot but he was only guessing.

I'm struggling to find the right medication for me and my DAS is about 4.5 but I don't qualify for an anti-TNF drug which requires a DAS over 5, I believe. My clinic check my score every time I go and barely glance at my feet or ankles which are in a bad way.

I'm wondering if I'm alone with this issue and if anyone (including any lovely members of the forum) has any advice.

Many thanks and wishing you all a good day,
Sophie :grin:


  • scattered
    scattered Member Posts: 326
    edited 30. Nov -1, 00:00
    It was explained to me by my RD and rheumy nurse that the DAS-28 doesn't include ankles and feet because the rest of the joints give exactly the same impression as the test did when it involved the ankles and feet. When they tested the difference between the DAS-28 and the DAS-48 (I think it was 48...) there was virtually no difference in the disease activity score given from each test. It was therefor decided to stick with the DAS-28 as it gave reliable results without taking up too much of the consultation time.

    However, it is problem as it means that the feet and ankles can be overlooked and not get examined as often as the rest of the joints.

    Hope that helps.
  • Starburst
    Starburst Member Posts: 2,546
    edited 30. Nov -1, 00:00
    Thank you, scattered. That was a very helpful and informative response. I understand now and that does make sense. I suppose it's just unfortunate that my feet and ankles are far worse than my other joints.
  • helpline_team
    helpline_team Posts: 2,275
    edited 30. Nov -1, 00:00
    Hi Starburst

    Thanks for your posting.

    I’m sorry to hear about the difficulties you are experiencing with your feet and ankles.

    For more information on the DAS scoring and treatment available see http://www.nras.org.uk/includes/documents/cm_docs/2010/d/das_know_your_das.pdf

    It says that if your score is between 3.2 and 5.1 you May merit a change in therapy. This sounds as though it is down to the discretion of the rheumatologist.

    The next time you go back to your rheumatologist you could mention the continued difficulties with your feet and ask again if you change medication.

    For more information on pain in the feet see http://www.arthritisresearchuk.org/arthritis_information/arthritis_types_and_symptoms/foot_pain.aspx .

    The orthopaedic specialist was correct in saying that there are many small bones in the feet, which is the reason for them not being counted.

    Scattered gave a very good response to your posting and if you post your question on the Living with arthritis forum you may well get more replies.

    Please ring our helplines if you would like to have a chat, or need more information.


    Helplines Team
  • helpline_team
    helpline_team Posts: 2,275
    edited 30. Nov -1, 00:00
    Hi Samuel

    I'm not sure exactly what type of insurance you are referring to but I doubt if DAS scores have an impact on insurance as peoples scores may vary with each visit to the doctor. The best thing to do would be to read through your insurance documents including the fine print. It may also help to give us a call to talk through what is going on for you.

    Best wishes