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Rheumatoid arthritis as one of the autoimmune diseases is more prevalent now than ever before. Being more common in women than men, RA has been focused by researchers to invent a therapeutic agent for effective clinical response. Various Diagnostic biomarkers are being used for early diagnosis of RA depending upon their selectivity and specificity. Certain indexes for RA disease activity evaluation are used for assessment of disease on a continuous scale. Disease activity Score combined with laboratory data result and imaging technologies makes the decision of treatment strategies easier than before. Traditionally, TNFi are the most used agents since a decade and first choice of treatment by clinicians, however, combination therapy with DMARD is used in inadequate responders. Despite all the advancements in treatment of RA and proved remission possibility using latest biological agents, studies are needed to ensure quick clinical outcomes and remission probability in larger fraction of people.

Introduction: The European League Against Rheumatism updates the recommendations for managing rheumatoid arthritis. Again, it is not specified which DAS28 is there in view (with erythrocyte sedimentation rate or C-reactive protein). Aim: The aim of the study is to check whether Disease Activity Score-28 (erythrocyte sedimentation rate) and Disease Activity Score-28 (C-reactive protein) represent equally the activity of rheumatoid arthritis in the course of treatment with biological agents. Materials and methods: In a retrospective study we analyzed the database of real clinical practice over a 12-month period of biological treatment of rheumatoid arthritis. Disease Activity Score-28 (erythrocyte sedimentation rate) and (C-reactive protein) are compared at the start and at the end of the study. Results: The mean difference between the two variants of disease activity scores at baseline and at the end of the study is significant (p < 0.001). The Disease Activity Score-28 (erythrocyte sedimentation rate) represents a remarkably small proportion of patients with remission and low activity ( Conclusion: The two DAS28 variants are not interchangeable with the same threshold for low activity in measuring the response to biological therapy.

The reliability and clinical usefulness of the different composite disease activity scores and their individual components in Rheumatoid Arthritis (RA) are still debated. This study investigated which measures of disease activity were preferred by rheumatologists. A mixed-method study was performed. First, ten Belgian rheumatologists were invited for individual interviews on their current practice and preferences for measurement of RA disease activity. Results of this qualitative study and evidence from literature served as input for developing a survey. This survey asked rheumatologists to rate preferred standard disease activity score(s), their individual components, ultrasound and related patient-reported outcomes (PROs), by maximum difference scaling. The relative importance score (RIS) for each indicator was calculated using hierarchical Bayes modeling. The qualitative study included 6/10 invited rheumatologists. Composite scores and components were perceived as useful, while PROs were found subjective. Interestingly, ultrasound was used to mediate discrepancies between physician and patient. The survey based on this was sent to 244 Belgian rheumatologists, 83/244 (34%) responded, including 66/83 (80%) complete and 17/83 (20%) incomplete surveys (two missing essential information). Most rheumatologists (75/81, 93%) used a disease activity score and 68/81 (84%) preferred the DAS28-CRP. Swollen joint count obtained the highest mean ± SD RIS (22.54 ± 2.64), followed by DAS28 ESR/CRP (20.61 ± 4.06), ultrasound (16.47 ± 7.97), CRP (13.34 ± 6.11) and physician's global assessment (12.59 ± 7.83). PROs including fatigue, pain, and patient's global assessment, and Health Assessment Questionnaire, obtained the lowest mean RIS (0.34-2.54). Rheumatologists place more faith in self-assessed disease activity components or in laboratory tests. Trust in PROs to evaluate disease activity is low in clinical practice. ispartof: RHEUMATOLOGY INTERNATIONAL vol:42 issue:5 pages:815-823 ispartof: location:Germany status: published

IntroductionRheumatoid arthritis (RA) is a chronic inflammatory arthritis that may lead to severe joint pain. There are several scores to evaluate the disease activity of RA. This study aimed to evaluate if clinical factors which representing activity scores and health assessment score.Material and methodsThis study was conducted prospectively by including adult patients with RA. Clinical factors and 5 RA disease activity and health assessment scores were evaluated. Each activity score was executed for clinical predictors by using multivariate linear regression analysis.ResultsThere were 33 female adult patients in the study. The average (SD) age was 52.33 (11.11) years, while the duration of RA was 7.65 years. The DAS28 ESR had 1 predictor: RA duration with a coefficient of –0.04. For DAS28 CRP, CDAI, and SDAI scores, body mass index (BMI) and RA duration were independent factors for the scores with negative coefficient values. For the HAQ score, both age and rheumatoid duration were positively associated with the score. The coefficients of both factors were 0.02 and 0.03, respectively.ConclusionsAge, RA duration, and BMI were associated with RA activity and functional score. Body mass index is a potential modifiable factor that may be associated with RA activities.

Objective To compare long-term clinical and radiographic outcomes among five sets of remission criteria [four clinical and one Ultrasound (US)-based] in a cohort of RA patients in a clinical care setting. Methods RA patients in remission (DAS28-ESR

Background The determination of rheumatoid arthritis (RA) activity remains an important clinical task nowadays and it is a long and difficult process. There is no single approach to assess the activity of RA. The gold standard for evaluating RA activity is composite indexes, for example, DAS28. However, composite indices are not reliable in evaluation of the disease activity in patients with RA, as having a subjectity assessment. New biomarkers that reflect the immune inflammatory process in joints in RA is of great scientific importance. 14-3-3η and calprotectin markers in plasma are considered as promissing. Objectives To assess the value of 14-3-3η and calprotectin in plasma as additional markers in RA activity determination. Methods 48 patients were examined with reliable diagnosis of RA, according to the ACR 2010 criteria. The mean age was 59 years, mean duration of the disease was 12.8 years. 4 patients in the group were in remission, 2 had low degree of RA activity, 20 - moderate, 22 – high. RA activity was determined according to the DAS28 ESR index. The concentrations of 14-3-3η and calprotectin in the blood plasma were determined by ELISA (LLC «SPF «Abris+»). The obtained results were compared with laboratory (ESR, CRP) and clinical (tender joint count (TJC), swollen joint count (SJC), VAS, DAS28) parameters of RA activity. Results 14-3-3η and calprotectin proteins in plasma and ESR highly correlated with DAS28 (r = 0.84; r = 0.65; r = 0.53), while CRP had moderate correlation with RA activity (r = 0.34). 14-3-3η and calprotectin proteins had high correlation with TJC (r = 0.68; r = 0.61) and moderate correlation with SJC (r = 0.56; r = 0.41); ESR and CRP had weaker correlation (r = 0.15; r = 0.13; r = 0.02; r = 0.08) respectively. The ROC analysis showed that sensitivity, specificity, and diagnostic accuracy of high RA activity determination are significantly higher for 14-3-3η (AUC = 0.98, p It was also found, that calprotectin (AUC = 0.8, p Conclusion 14-3-3η and calprotectin proteins in plasma are new promising biomarkers of immunoinflammatory process in joints in RA assessment, because they are more sensitive and specific markers of the disease activity, than conventional acute-phase proteins ESR and CRP. Disclosure of Interests None declared

Background:For treating Rheumatoid Arthritis (RA) it’s clear that Treat to Target has presented the best strategy. The best outcome for patients has been attained by accepting clinical remission as the final objective in treatment. The development of new drugs for the treatment of RA has dramatically modified the approach clinicians have on the disease, however, the treatment of inflammatory conditions represents a challenge due to the multiple factors can affect its response.It is known that non-adherence represents an increase in mortality, morbidity and healthcare costs.1,2.Emphasis should be made on one of the most simple and effective variables that impact the effectiveness of treatment: adherence to treatment itself.Objectives:This work aimed to evaluate the impact of methotrexate adherence on treatment outcome in patients with RA.Methods:An observational, cross sectional study was performed using medical records from the Rheumatology Clinic at University Hospital from UANL Jose Eleuterio Gonzalez, Monterrey, México; the data was collected from 03/16/2018 to 01/29/2020. RA patients visits included fulfilled the 2010 ACR/EULAR classification, had their disease activity measured by Disease Activity Score 28 ESR (DAS28 ESR) and were treated with methotrexate as their primary disease modifying antirheumatic-drug (DMRAD). Patient disease activity was classified in 4 groups according to the DAS28 ESR score as 3.2-5.1 moderate activity, >5.1 high activity.Adherence to medication was evaluated utilizing a self-reported assessment that was applied per patient’s visit. Patients were classified into 4 groups according to the percentage of the prescribed doses of Methotrexate that they abided to. Statistical analysis was performed using IBM SPSS 21 statistical package. Descriptive analyses were performed with frequencies (%) and the correlation between the calculated disease activity versus patient adherence to treatment was calculated using Pearson correlation coefficient.P-values Results:A total of 795 patients visits were included. They were 92.33% female, mean (SD) age was 52.44 (±12.99) (Table 1). The most frequent routes for methotrexate were Oral 603 (75.84%), Subcutaneous 113 (14.21%) and Intramuscular 79 (9.93%). A significant correlationr(795) =0.-183, (pTable 1.Baseline CharacteristicsN= 795Age, mean SD52.44 (±12.99)Sex, n (%) Female734 Male61Methotrexate (mg/week)Average Dose19.94Median Dose20Intramuscular79 (9.93%)Subcutaneous113 (14.21%)Oral603 (75.84%)Disease Activity accordingto DAS28 ESR, n (%)Remission343 (42.3)Low activity101 (12.5)Moderate activity292 (36.0)High activity59 (7.3)Adherence classification according to prescribed doses taken, n (%)Absent (20 (2.5%)Poor (25-49%)19 (2.3%)Regular (50-74%)55 (6.8%)Adequate (>75%)701 (86.5%)Conclusion:Adherence to treatment with methotrexate therapy has a direct impact on RA treatment outcome. The evaluation of adherence to the prescribed treatment should be addressed before modifications in DMRAD therapy in patients with Rheumatoid Arthritis. Before considering treatment failure in a patient treated with methotrexate, adherence to treatment must be evaluated. According to our results, self-reported adherence appears to be a cost and time effective method to care for patients.References:[1]Monchablon C, et. al. Assessment adherence to disease-modifying anti-rheumatic drugs in rheumatoid arthritis. Clinical Rheumatology. 2019;39(1):207-216.[2]Scott DL, et al. (2010) Rheumatoid arthritis. Lancet 376:1094–1108.Disclosure of Interests:None declared

Background:Tight control of rheumatoid arthritis (RA) is essential and we need a validated, objective and reproducible disease measure to achieve it. There is not gold standard in RA. There is a rising interest in evaluating disease activity on the patient’s point of view using patient-reported outcomes like RAPID3. Furthermore, some new biomarkers have appeared, like serum calprotectin, with promising results on its analyzing.Objectives:To evaluate correlation between disease activity measures usually used in patients with RA (DAS28 ESR/CRP, SDAI and CDAI) and other alternative tools (RAPID3 and calprotectin). To analyze correlation between RAPID3 and serum calprotectin levels.Methods:A cross-sectional study was performed. RA-patients (n=114) according to the ACR/EULAR 2010 classification criteria were consecutively enrolled from Rheumatology department at Hospital de Figueres during the period from February to June 2019. Disease activity, biomarkers and the assessment of the patient’s health status with RAPID3 data were collected. Modified RAPID3 (mRAPID3) was calculated by subtracting the questions about the mood included in the questionnaire (k,l,m questions) to the results of the RAPID3 as if it were a response of the HAQ test. Coefficient Spearman’s correlation (r) was used to assess the relationship between the variables, and coefficient of determination (r-squared=r2and adjusted r2) was used to show the strength of correlation.Results:114 patients were included: 71% women, mean (SD) age 60(11) years, median disease duration 13(8) years. 80% had positive RF and 70% positive ACCP antibodies. 52% had erosions. 89% patients had been receiving treatment with csDMARDs, 38% with bDMARDs o dsDMARS and 66% with glucocorticoids. Disease activity measures’ median values were DAS28ESR 3.07, DAS28CRP 2.76, SDAI 9.62 and CDAI 8.99 and showed low activity. The mean values of RAPID3 y mRAPID3 showed moderate activity (8.95 and 8.68 respectively). Median serum calprotectin level was 1.48μg/ml.All correlations between variables were statistically significant and directly proportional although with different values (table).Spearman’s correlation coefficient between mRAPID3, serum calprotectin, disease activity scores and laboratory parametersmRAPID3CalprotectinCRPESRDAS28ESRDAS28PCRSDAICDAImRAPID31Calprotectin0.231CRP0.330.591ESR0.230.390.541DAS28-ESR0.620.320.410.621DAS28-CRP0.690.320.420.280.831SDAI0.740.310.350.270.820.911CDAI0.730.250.240.210.800.890.991DAS28: Disease Activity Score, SDAI: Simplified Disease Activity Index, CDAI: Clinical Disease Activity Index, RAPID3m: Routine Assessment of Patient Index Data 3 modificative with k,l,m questions. CRP: C-reactive protein. ESR: erythrocyte sedimentation rateCoefficient of determination found a weak association between RAPID3 and mRAPID3 with DAS28ESR (r2=0,38) and moderate with DAS28CRP, SDAI and CDAI (r2=0,47, 0,55 y 0,53). Determination serum calprotectin levels together with RAPID3 or mRAPID3 increased strength of correlation between DAS28ESR, DAS28CRP, SDAI and CDAI with RAPID3 (adjusted r2=0,40, 0,49, 0,56, 0,52) and with mRAPID3 (adjusted r2=0,41, 0,50, 0,56, 0,53). Correlation between RAPID3 and serum calprotectin levels was very weak (r2=0,05).Conclusion:Correlation between disease activity measures and mRAPID3 was strong, but it was weak with serum calprotectin levels. Correlation strength between RAPID3 and DAS28ESR was low and it was moderate with other composite indices, it maintained with RAPID3m and improved by adding serum calprotectin levels although modestly. There was a very weak correlation between RAPID3 and serum calprotectin levels suggesting that these two variables give us different information about the disease activity.Acknowledgments:Mrs. Dolors Ragolta. Mr. Carlos Sanchez Piedra and Mr. Fernando Sanchez AlonsoDisclosure of Interests:None declared

Objectives To evaluate determinants of discordance between DAS28-ESR and DAS28-CRP and resulting impact on disease activity stratification in RA. Methods Paired DAS28-ESR and DAS28-CRP readings (n = 31 074) were obtained from the British Society for Rheumatology Biologics Register for RA. Factors influencing discordance between DAS28-ESR and DAS28-CRP were evaluated alongside the resulting effect on disease activity stratification. The impact of gender adjustment to the DAS28-CRP was evaluated. Results DAS28-CRP scores were ∼0.3 lower than DAS28-ESR overall, with greatest differences for women (−0.35) and patients over 50 years old (−0.34). Mean male DAS28-CRP scores were 0.15 less than corresponding DAS28-ESR scores. Discordance between DAS28-ESR and DAS28-CRP significantly impacted disease activity stratification at low disease activity and remission thresholds (32.0% and 66.6% concordance, respectively). Adjusting DAS28-CRP scores by gender significantly (P < 0.001) improved agreement with the DAS28-ESR. Conclusion Discordance between DAS28-ESR and DAS28-CRP is greatest for women and patients over 50 years of age, and influences disease activity stratification. The proposed gender-adjusted DAS28-CRP improves inter-score agreement with DAS28-ESR, supporting more reliable disease activity stratification in treat-to-target approaches for RA.

Background The Routine Assessment of Patient Index Data 3 (RAPID3) is a patient reported outcome (PRO) proposed to conveniently measure disease activity in rheumatoid arthritis (RA) based on functioning, pain and global health scores. DAS28 (including PRO and objective measures) is the most frequently used score in clinical practice and research for that purpose[1]. It has been suggested that composite scores measuring PROs only (e.g. RAPID3) might add to the assessment of disease activity over time but this claim is yet to be formally tested. Objectives In this study we evaluated a possible longitudinal association between RAPID3 and DAS28-ESR (including individual components) in patients with RA from daily clinical practice. Methods Adult patients with RA on stable treatment with either conventional synthetic disease modifying drugs (csDMARDs) and/or biologic DMARDs (bDMARDs), followed in one centre, were included. Patients were followed every 3 months up to 3 years and in each visit both clinical and medication data was collected by rheumatologists/research nurses. The longitudinal association between RAPID3 (range: 0–30) with DAS28-ESR and its individual components [tender joint count (TJC; 0–28); swollen joint count (SJC; 0–28); patient global assessment (PGA; 0–10) and ESR (mm/h)] was tested (in separate models) by longitudinal generalised estimating equations (GEE) with auto-regression. Interactions between RAPID3 with gender (male vs female), VAS pain (≥5 vs Results In total, 330 patients were included [mean (SD) age: 6212 years, 68% female, baseline mean (SD) DAS28: 3.3 (1.4) and RAPID3: 11.5 (6)]. The mean (SD) follow-up period was 10.7 (9.7) months. Although, statistically significant, we only found a poor association between RAPID3 and DAS28-ESR over time (table 1). An increase of one unit in RAPID3 (0–30) was associated with an increase of only 0.1 units of DAS28-ESR. Gender, age, PGA and VAS pain were not found to meaningfully modify the association between RAPID3 and DAS28. A far stronger association was found between RAPID3 and the ‘subjective components’ [TJC: β=0.30 (95%: 0.20; 0.39); and PGA: β=0.31 (95%: 0.28; 0.35)] of DAS28-ESR, as compared to the ‘objective components’ (i.e., SJC and ESR; the latter only significant in males) (table 1). Conclusions There is no meaningful longitudinal association between RAPID3 and DAS28. DAS28 captures objective signs of disease activity over time in RA while RAPID3 only captures subjective symptoms of RA. Reference [1] Van der Heijde DM, et al. Development of a disease activity score based on judgment in clinical practice by rheumatologists. J Rheumatol1993.20:579–581. Disclosure of Interest None declared

Background DAS28-ESR is the most widely used instrument to assess remission in rheumatoid arthritis (RA) patients. Nonetheless, substantial residual disease activity can be present in RA patients fullfilling DAS28-ESR remission. Therefore, more stringent criteria for remission have been developed. While it is known that patients can fulfil DAS28-ESR but fail ACR/EULAR Boolean remission criteria, the existence of the reverse is less known. Objectives To test the possibility to loose DAS28-ESR remission while staying in ACR/EULAR remission in patients with RA Methods Data were obtained from the prospective randomised RETRO study (EudraCT: 2009–015740–42), which recruits RA patients in stable remission. Remission was assessed by the following instruments every three months: DAS28-ESR, DAS28-CRP, CDAI, SDAI, PAS, and ACR/EULAR criteria. In the group of patients, escaping DAS28-ESR remission, but fulfilling ACR/EULAR Boolean remission, the individual components of DAS28-ESR were analysed that determined their escape from remission. Results 142 patients analysed, which were all in DAS28-ESR remission at baseline. Of them, 140 (98.59%) were in DAS-CRP-remission, 131 (92.25%) in CDAI-remission, 130 (91.55%) in SDAI-remission, 109 (76.76%) in ACR/EULAR remission and 66 (46.48%) in PAS-remission. We analysed upon the 1 year follow up those patients loosing DAS28-ESR remission over time: 58 patients lost DAS-ESR remission at least once during the 4 follow-up visits. Surprisingly, 24% (3 months), 36% (6 months), 24% (9 months) and 28% (12 months) of the patients still fulfilled the Boolean remission criteria. The only plausible reason for failing DAS28-ESR remission but staying in ACR/EULAR remission is an isolated elevation of the ESR, not accompanied by increased signs and symptoms of disease. Indeed all patients loosing DAS28-ESR remission but staying in ACR/EULAR Boolean remission had an elevated ESR equal or higher than 15 mm. However, if DAS28 scores were calculated by C-reactive protein in the same patients, they all fulfilled remission criteria. Conclusions DAS28-ESR remission can be missed even if a patient fulfils the more stringent ACR/EULAR Boolean remission criteria. The reason for this remarkable constellation is an elevated erythrocyte sedimentation rate without any clinical symptoms. Hence, isolated elevations of erythrocyte sedimentation rate should be seen critical. These data show the limitations of individual instruments to assess remission in RA and show that interpretations of the erythrocyte sedimentation rate need to be done in the clinical context Disclosure of Interest None declared

Background In most patients with rheumatoid arthritis (RA), Disease Activity Score 28-joint count C reactive protein (DAS28-CRP) is lower than DAS28 erythrocyte sedimentation rate (DAS28-ESR), suggesting that use of the DAS28-ESR cut-off to assess high disease activity (HDA) with DAS28-CRP may underestimate the number of patients with HDA. We determined the DAS28-CRP value corresponding to the validated DAS28-ESR cut-off for HDA. Methods Baseline data were pooled from 2 clinical studies evaluating etanercept (ETN) plus methotrexate (MTX) or MTX in early RA; DAS28-CRP and DAS28-ESR were obtained, allowing the determination of the DAS28-CRP HDA value best corresponding to the DAS28-ESR cut-off of >5.1. Results At baseline, as expected, fewer patients had HDA by DAS28-CRP than DAS28-ESR; DAS28-CRP>5.1 and DAS28-ESR>5.1 had only modest agreement (κ coefficients 0.45–0.54). Mean DAS28-CRP and DAS28-ESR were 5.7 and 6.2, respectively, in the ETN+MTX group (n=571), and 6.0 and 6.5 in the MTX group (n=262). A DAS28-CRP cut-off of 4.6 corresponded to a DAS28-ESR cut-off of 5.1. Conclusions We have shown that a DAS28-CRP of 4.6 corresponds to 5.1 for DAS28-ESR. Since this is substantially lower than the DAS28-ESR cut-off of 5.1, using 5.1 as the cut-off for DAS28-CRP underestimates disease activity in RA. Trial registration number NCT00195494; NCT00913458.

Resumo Introdução: O Disease Activity Score 28 (DAS28) e versões têm sido usados para medir atividade da artrite reumatoide (AR), mas não existe consenso sobre qual é o melhor. Objetivos: Determinar a correlação entre os índices (DAS28 VHS, DAS28 PCR, SDAI e CDAI) e avaliar a concordância dos estratos de atividade com o uso de diferentes pontos de corte. Métodos: Pacientes com artrite reumatoide foram avaliados transversalmente com coleta de dados para cálculo do DAS28 (VHS e PCR), SDAI e CDAI, com o uso de pontos de cortes diferentes para definição de remissão, atividade leve, moderada e alta. Correlações de Pearson foram calculadas para medidas contínuas e concordância (teste de kappa) para os estratos (remissão, atividade leve, moderada e alta). Resultados: De 111 pacientes incluídos, 108 foram mulheres, média de 55,6 anos, tempo de doença de 11 anos. DAS28 (VHS) foi significantemente maior do que DAS28 (PCR) (4 vs. 3,5; p < 0,001) e os valores permaneceram maiores após estratificação por idade, sexo, tempo doença, fator reumatoide e HAQ. Correlações entre índices variaram de 0,84 a 0,99, com melhor correlação entre SDAI e CDAI. Concordâncias entre estratos de atividade variaram de 46,8% a 95,8%. DAS28 (PCR) com ponto de corte para remissão de 2,3 subestimou atividade da doença em 45,8% quando comparado com DAS28 (VHS). SDAI e CDAI apresentaram concordância de 95,8%. Os quatro índices mostraram associação com tempo de doença e HAQ. Conclusões: Embora os índices de atividade apresentem boa correlação, mostram discrepâncias nos estratos de atividade. Tornam-se necessários mais estudos para definir melhor índice e melhores pontos de corte. Abstract Introduction: The Disease Activity Score 28 (DAS28) and its versions have been used to measure rheumatoid arthritis activity, but there is no consensus about which one is the best. Objectives: Determine the correlation among indexes (DAS28 ESR, DAS28 CRP, SDAI and CDAI) and evaluate agreement of activity strata using different cut-off points. Methods: Rheumatoid arthritis patients were cross-sectionally evaluated with data collection to calculate the DAS28 (ESR and CRP), SDAI and CDAI, using different cut-offs for defining remission, mild, moderate and high activity. Pearson correlations were calculated for continuous measures and agreement (kappa test) for the strata (remission, mild, moderate and high activity). Results: Of 111 patients included, 108 were women, age 55.6 years, 11-year disease duration. DAS28 (ESR) was significantly higher than DAS28 (CRP) (4.0 vs. 3.5; p < 0.001) and the values remained higher after stratification by age, gender, disease duration, rheumatoid factor and HAQ. Correlations among indexes ranged from 0.84 to 0.99, with better correlation between SDAI and CDAI. Agreements among activity strata ranged from 46.8% to 95.8%. DAS28 (CRP) with cut-off point for the remission of 2.3 underestimated disease activity by 45.8% compared with DAS28 (ESR). SDAI and CDAI showed agreement of 95.8%. The four indexes were associated with disease duration and HAQ. Conclusions: Although the activity indexes show good correlation, they show discrepancies in activity strata, thus requiring more researches to define a better index and better cut-off points.

OBJECTIVES To investigate whether a difference exists between DAS28 from CRP and DAS28 from ESR in patients with rheumatoid arthritis (RA) and secondary Sjogren's syndrome (sSS). MATERIAL AND METHODS One group comprised patients with RA and sSS, the control group comprised patients with RA. The inclusion criteria for the RA and sSS group have been specified as follows: presence of at least one symptom of dryness, and also presence of anti-SS-A and anti-SS-B or at least focus score of one in biopsy. RESULTS The disease activity score 28 (DAS28) was assessed using both ESR and CRP in 60 patients with RA and sSS and 59 patients with RA alone. However, concordance between these two methods was good (Cohen's κ coefficient κ = 0.60, 95% CI: 0.45-0.75 in the first group and κ = 0.71, 95% CI: 0.56-0.86 in the control group). In the group with RA and sSS, the mean value of DAS28-ESR = 5.2, whereas the mean value of DAS28-CRP = 4.7 (p < 0.0001). In the group with RA alone, mean DAS28-ESR = 4.7 while mean DAS28-CRP = 4.6; no significant difference was identified. Moreover, in RA patients with sSS, mean ESR = 39 mm/h compared with mean CRP at 25 mg/l. 79% of all patients demonstrated dysproteinaemia. There were connections between higher ESR and dysproteinaemia. In the control group there was no statistically significant difference between CRP and ESR. CONCLUSIONS Both DAS28-ESR and DAS28-CRP are useful outcome measures in RA. However, in patients with RA and sSS, DAS28 should be evaluated based on CRP.