Finally, I’m put off by the implication that rheumatologists only perform joint exams if forced to do so by the exercise of deriving a DAS. Most of us look at and palpate almost every joint at every office visit; we just don’t record a tally.
Rheumatologists need to know what a DAS is and how to obtain one. We need to order CRPs and X-rays and MRIs when clinically appropriate. We need to assess our patients’ function and pain. We need to understand that a patient can feel well and look well, but still have synovitis and develop progressive erosions and loss of function over time. But forcing us to “objectify” an exceptionally complex scenario is not in the best interest of the patient or the clinician.
Barry Waters, MD, Coral Springs, Fla.
DAS, HAQ, and EMR
I greatly enjoyed your article on the use of the DAS and HAQ in RA. I am a rheumatologist in eastern North Carolina. For the past five years I have used the DAS-28 in my patients with RA. Although two companies have also given me the DAS calculator you referred to in your article, I have found the DAS Web site in the Netherlands, www.DAS-score.nl, very simple. My nurses input the data from my DAS data sheet and that number in my EMR [electronic medical record].
Monitoring serial DASs has benefited my patients a great deal. I have also had to use the scores a handful of times to petition insurance companies to pay for a BRM [biological response modifier] in certain patients.
My use of and experience with DAS, and now the HAQ, mirrors yours. In late 2005 I started using the Mini-HAQ in my practice. Currently I am trying to set up a touch-screen tablet PC for my patients to directly input their HAQ responses into my EMR. The learning curve has been far steeper for me with the HAQ than the DAS. I am hopeful that using the HAQ in RA and other [connective tissue diseases] will allow me greater flexibility in treating my patients.
Certainly the use of the DAS has allowed me to be more aggressive in the use of BRMs and aggressive combination therapies. In talking to patients about their disease, now “I have a number to throw at them.” At first patients were upset about “another piece of paper for me to fill out,” but now it is commonplace for them to start the forms and it takes me virtually no time to complete the data sheets.