DAS28

What the research found.

• One review pooled trials of following a protocol toward a combined target that included a blood marker of inflammation. More people reached remission than under ordinary care, and the biggest difference was 65 percent against 16 percent. One trial steered by the DAS28 itself reached 38 percent against 21 percent.

  Hock and colleagues, SN Comprehensive Clinical Medicine, 2021

• One pooled analysis looked at mindfulness in rheumatoid arthritis, across 5 trials and 399 people. The DAS28-CRP effect was minus 0.44, with a true value somewhere from minus 0.99 to 0.12. That range crosses zero, so chance could explain it.

  DiRenzo and colleagues, Current Rheumatology Reports, 2018

• One trial tested exercise in well-controlled rheumatoid arthritis, where maximal oxygen uptake rose by 3.71 and waist size fell by 2.6 centimeters. The DAS28 showed no clear change at all. So two real gains turned up without the score noticing either of them.

  Bilberg and colleagues, British Journal of Sports Medicine, 2024

• One trial gave people an anti-inflammatory diet and a control diet in turn, and the DAS28-ESR didn't differ between them on the test the trial planned in advance, at a P value of 0.116. A P value of 0.04 also gets quoted. That one comes from an unplanned test using only the 44 people who finished both periods.

  Vadell and colleagues, American Journal of Clinical Nutrition, 2020

• One review pooled 71 studies, where low mood and anxiety went with DAS28 remission at an odds ratio of 1.77. The true value sits somewhere from 1.36 to 2.29. Its authors report three things in those patients: lower remission rates, more disability, and higher death rates.

  Sweeney and colleagues, Rheumatology International, 2024

What the number is made of

The DAS28 is a combined score, which is the whole point of it and the source of most confusion about it. It takes a count of tender and swollen joints from a set list of 28, it takes a blood marker of inflammation, and it takes your own rating of your health. Those three inputs get combined into one figure.

Putting three kinds of information into one number was a design choice, and a sensible one. A doctor's exam goes in, a lab result goes in, and your own judgment goes in, because no one of those three tells you enough on its own. Joint counts miss what you feel, blood markers read normal in many people with active disease, and your own rating moves with sleep, with mood, and with everything else in a life.

The cost of that design is simple. A score that fell by half a point doesn't say whether two swollen joints settled, whether a marker drifted down, or whether you rated a better week. Asking which part moved is the more useful question, rather than asking what the total came to.

What it decides

The score's real job is to trigger a decision. One review pooled randomized trials where some patients followed a protocol toward a combined target that included a blood marker of inflammation, and more of them reached remission than under ordinary care. The biggest difference reported was 65 percent against 16 percent.

Other trials in that review pointed in the same direction. One of them was steered by the DAS28 itself and reached 38 percent against 21 percent, while three further trials reported differences of a similar size to each other. So having a target won, and treating by impression didn't.

That's an argument for the method rather than for the number itself. A combined score is a decision rule, and what the review shows is that following a rule beats not following one. This page prints no cut-off values, because we hold no source for them, and a threshold quoted from memory is the kind of number a reader will act on without checking where it came from.

Why lifestyle studies keep missing it

One thing is worth knowing before you read any study of diet or exercise on this site. The DAS28 is a hard outcome to move, and trial after trial improves something real and then leaves the score where it was. That's a consistent finding rather than a run of bad luck.

One pooled analysis looked at mindfulness in rheumatoid arthritis, across 5 trials and 399 people, where the DAS28-CRP effect was minus 0.44 with a true value running from minus 0.99 to 0.12. An exercise trial in well-controlled disease raised maximal oxygen uptake by 3.71 and cut waist size by 2.6 centimeters while the score showed no clear change. A third trial gave people two diets in turn, and the DAS28-ESR didn't differ between them on the test planned in advance, at a P value of 0.116.

The last of those deserves a closer look, because it's widely quoted as showing the opposite. A second result from that trial has a P value of 0.04, from a test that wasn't planned in advance, using only the 44 people who finished both periods. Its title reads as positive while its main test found nothing, which is how a trial that found nothing becomes a citation saying diet lowers disease activity.

What a flat score does and doesn't mean

One trial improved fitness without moving the DAS28, and it still improved fitness. Rheumatoid arthritis comes with raised heart risk, so a gain in maximal oxygen uptake is worth having, and so is a smaller waist. Reading those as a failure reads them against the wrong score, because that score was built for a different purpose.

The reverse caution applies too. The largest review here covers rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis, and it does report one thing, which is that omega-3 reduced the DAS28 in rheumatoid arthritis. So this isn't a claim that nothing outside a prescription pad moves the number. Our record for that review gives no effect size, so this page quotes the direction and not a figure.

The run of flat results argues against one particular reading. Don't read a lifestyle change as a treatment substitute, because something that makes you fitter is worth doing and something that helps you sleep is worth doing, and neither one is evidence of less inflammation. Those are separate claims, and the score is the thing that keeps them separate.

The score in remission and the person who isn't

A number in the remission range describes joints and a blood marker rather than a life, and that's the part that gets lost when a score becomes the goal. The clearest data on the difference comes from sleep. It's worth reading if your own numbers look better than you feel.

One study asked 313 adults with three inflammatory arthritis diagnoses between them about sleep, where the disease was mostly quiet or nearly quiet. Even so, 63.7 percent with rheumatoid arthritis slept badly. It was 61.5 percent in psoriatic arthritis and 66.7 percent in axial spondyloarthritis, and that study looked at people at one moment, so it describes things happening together rather than one causing the other.

Mood belongs in the same section. One review pooled 71 studies, where low mood and anxiety went with DAS28 remission at an odds ratio of 1.77, with a true value running from 1.36 to 2.29. Its authors report lower remission rates, more disability, and higher death rates in those patients. Data that only watches can't separate distress worsening the disease from the disease causing the distress. Either way, mood belongs at a rheumatology visit.

Common misconceptions.

Related terms.

• Rheumatoid arthritis and blood tests, for what each component test can and can't tell you.
• Remission, which is a definition rather than a feeling.
• Inflammation, and the difference between the kind you can measure and the kind you have.
• CRP and ESR, the two markers the score can be built on.

Questions patients ask.