DAS28 in daily clinical practice

The DAS28 can be very helpful in daily clinical practice. Treatment decisions can be based on current DAS28 values or on changes in DAS28 compared to values before the start of the treatment. This approach has several advantages. For one, the DAS28 and its thresholds for high and low disease activity have been extensively validated. Moreover, there is a clear relationship between the mean DAS during a certain period and the amount of radiographic damage that the patient develops in that timeframe. 

Here we give some examples how to "titrate" your treatment to the individual patient based on the DAS28. The given examples are based on real patients being treated with a TNF blocking agent. The same principle can be applied to conventional DMARD therapy. 

No treatment is given while the patient is demonstrating low disease activity. When the DAS28 exceeds 3.2, therapy is resumed. This approach is not dependent on baseline values. Evaluations are performed every two weeks in this example but can also be done less often.