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Peripheral inflammatory arthropathies other than rheumatoid arthritis
CRP tends to be less responsive in psoriatic arthritis than in RA: many patients with active disease will have normal or minimally elevated readings. Tender and swollen joint counts provide useful information in any inflammatory arthritis. HAQ-DI appears to be a useful measure of function in most arthropathies. The validity of DAS28 has been tested in psoriatic arthritis and appears to perform reasonably well. It would be expected to perform better in patients with peripheral polyarthritis than in patients with enthesopathy and spondylitis or mono/oligoarthritis. For patients with atypical or undifferentiated forms of arthritis it is probably more helpful to measure individual parameters than composite indices.
Axial inflammatory disease (spondyloarthritis, SpA)
Various tools have been developed and validated for the assessment of disease activity (BASDAI), range of movement (BASMI) and function (BASFI) in ankylosing spondylitis. For a patient with spondyloarthritis other than AS, e.g. non-radiographic axial SpA, undifferentiated arthritis with predominantly inflammatory back pain or PsA with predominantly axial symptoms, the AS tools are likely to reflect disease activity more accurately than the tools developed for RA.
Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) This is a patient-reported composite score of various symptoms that reflect inflammatory disease in AS, and by implication in axial SpA. The questions relate to fatigue, spinal pain, tenderness, joint pain and swelling, and pain and stiffness in the morning. A score of above 6 is one of the pre-requisites for access to a TNF inhibitor.
Exercise Enter various values in this on-line calculator to familiarize yourself with level of symptoms behind a range of BASDAI scores.
Extra reading If you would like to extend your knowledge beyond the requirement for this module, and possibly beyond that of your local rheumatologists, you may wish to read the following: Anderson J et al. Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice. Arthritis Care Res (Hoboken). 2012 May;64(5):640-7. doi: 10.1002/acr.21649. The article is available on PubMed here.
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