DAS28 (ESR)

The DAS28 (Disease Activity Score, 28 joints) compresses four measurements — tender and swollen joint counts, an acute-phase reactant (here: ESR), and the patient's own global assessment — into a single number that tracks rheumatoid arthritis activity. It is the workhorse score behind treat-to-target: therapy is adjusted until remission or low disease activity is reached.

High-yield: DAS28 thresholds — <2.6 remission, ≤3.2 low, ≤5.1 moderate, >5.1 high disease activity. Treat-to-target means reassessing at most every 3 months and adapting therapy if the target is not met.

How to use it

Count tender and swollen joints among the 28 assessed joints (shoulders, elbows, wrists, MCPs, PIPs, knees — hips, ankles and feet are not included). Enter the ESR in mm/h and the patient's global health on a 0–100 visual analogue scale (0 = very well, 100 = very poor).

Don't miss: the VAS is 0–100, not 0–10 — a tenfold error here materially shifts the score. And the ESR version of DAS28 cannot be interchanged with the CRP version (DAS28-CRP): their cut-offs differ slightly.

Interpretation

DAS28-ESR	Disease activity
< 2.6	Remission
2.6 – 3.2	Low
3.2 – 5.1	Moderate
> 5.1	High

Improvement criteria (EULAR response) combine the absolute DAS28 with the magnitude of change (>1.2 = major improvement, 0.6–1.2 moderate, ≤0.6 none).

References

Prevoo ML, et al. Modified disease activity scores that include twenty-eight-joint counts. Arthritis Rheum 1995;38:44–48.
Smolen JS, et al. EULAR recommendations for the management of rheumatoid arthritis: 2023 update. Ann Rheum Dis 2024;83:15–29.
van Gestel AM, et al. Development and validation of the European League Against Rheumatism response criteria. Arthritis Rheum 1996;39:305–314.

Draft content — verify against the cited sources before relying on it.