Glossary
DAS28
The DAS28 steers your treatment decisions. It's also the number lifestyle trials keep failing to move, while they improve fitness, tiredness, and how people rate their own health. The score stays where it was.
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 rises and falls 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.
Common misconceptions.
Myth. A falling DAS28 means my disease is settling down.
Reality. It usually does mean that, and the score can't tell you which of its parts moved. Three things feed into one figure, which are joint counts, a blood marker of inflammation, and your own rating of your health, so a fall can come from any of them. Ask which part changed at your next visit, because that's a more useful question than asking what the total is, and the answer changes what should happen next.
Myth. A remission score means I'll feel well.
Reality. It doesn't, and that difference is one of the harder parts of this diagnosis. One study asked 313 adults with inflammatory arthritis about sleep, where the disease was mostly quiet or nearly quiet, and 63.7 percent with rheumatoid arthritis still slept badly, with 61.5 percent in psoriatic arthritis and 66.7 percent in axial spondyloarthritis. So controlling the score is a different achievement from feeling well.
Myth. A trial showed that an anti-inflammatory diet lowers disease activity.
Reality. The trial people quote for that didn't show it, because its own main test found nothing. The DAS28-ESR didn't differ between the two diets on the test planned in advance, at a P value of 0.116. The result people quote has a P value of 0.04, it comes from a test that wasn't planned, and it used only the 44 people who finished both periods of the trial.
Myth. If exercise doesn't lower my score it isn't doing anything.
Reality. One trial was done in well-controlled rheumatoid arthritis, where maximal oxygen uptake rose by 3.71 and waist size fell by 2.6 centimeters while the DAS28 showed no clear change. Those are real gains in heart and lung fitness, in a disease that raises heart risk on its own. The score was built to steer drug treatment rather than to measure everything worth having.
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.
References.
- Hock E; Martyn-St James M; Wailoo A et al. Treat-to-Target Strategies in Rheumatoid Arthritis: a Systematic Review and Cost-Effectiveness Analysis. SN Comprehensive Clinical Medicine. 2021;3:838-854. 10.1007/s42399-021-00727-4Systematic review of randomised controlled trials
- DiRenzo D; Crespo-Bosque M; Gould N et al. Systematic Review and Meta-analysis: Mindfulness-Based Interventions for Rheumatoid Arthritis. Current Rheumatology Reports. 2018;20. 10.1007/s11926-018-0787-4Systematic review and meta-analysis of mindfulness-based interventions in rheumatoid arthritis
- Bilberg A; Mannerkorpi K; Borjesson M et al. High-intensity interval training improves cardiovascular and physical health in patients with rheumatoid arthritis: a multicentre randomised controlled trial. British journal of sports medicine. 2024;58:1409-1418. 10.1136/bjsports-2024-108369RCT
- Vadell AKE; Bärebring L; Hulander E et al. Anti-inflammatory Diet In Rheumatoid Arthritis (ADIRA)-a randomized, controlled crossover trial indicating effects on disease activity. The American Journal of Clinical Nutrition. 2020;111:1203-1213. 10.1093/ajcn/nqaa019Randomized controlled crossover trial
- Sweeney M; Adas M; Cope A et al. Longitudinal effects of affective distress on disease outcomes in rheumatoid arthritis: a meta-analysis and systematic review. Rheumatology International. 2024;44:1421-1433. 10.1007/s00296-024-05574-9Systematic review and meta-analysis of longitudinal observational studies
- Polak D; Kolasińska M; Wilk M et al. Sleep disorders in RA, axSpA and PsA are common despite good disease activity control—direct comparison of sleep quality and its risk factors using MDHAQ and PSQI. Clinical Rheumatology. 2026;45:957-965. 10.1007/s10067-025-07892-0Cross-sectional study of 313 adults from the PolNorRHEUMA registry: RA n = 129
- Van den Bruel K; Kulyk M; Neerinckx B et al. Nutrition and diet in rheumatoid arthritis, axial spondyloarthritis, and psoriatic arthritis: a systematic review. Frontiers in medicine. 2025;12:1655165. 10.3389/fmed.2025.1655165SR
This page gathers the published research on this subject into one place. The studies behind it were published between 1989 and 2026, and every figure links to the paper it came from. Those studies were peer reviewed. This summary of them was not. Dr. Sarah Luebker is reviewing these pages one at a time and has not reached this one yet, so it carries no medical review date and nothing here is her opinion or her advice to you. Each page gets updated as she reaches it. It is here in the meantime because the science is worth having in one organized place that is easy to find and easy to read. Talk to your own clinician before acting on any of it.