Comparison between the Improvements in Disease Activity Score 28 (DAS28) Using Erythrocyte Sedimentation Rate (DAS28-ESR) and Clinical Parameters in Cases of Waja-al-Mafasil (Rheumatoid Arthritis)

Abstract

Waja-al-Mafasil (Rheumatoid Arthritis) is a progressive, disabling, chronic multisystem disease of unknown cause characterized by pain, swelling and stiffness of synovial joints. The Disease Activity Score (DAS) is a major scoring system for evaluating disease activity of Waja-al-Mafasil (Rheumatoid Arthritis). DAS28 was originally using the erythrocyte sedimentation rate (ESR) as the inflammation marker and named DAS28-ESR. The aim of this study to compare the improvement in disease activity score 28 using erythrocyte sedimentation rate (DAS28-ESR) and clinical parameters in the patients of Rheumatoid Arthritis. Rheumatoid Arthritis patients registered in research OPD was used to calculate DAS28-ESR and clinical assessment. In this study, Majun Jograj Gugal (Semisolid) and Raughan-e-Malkangani (Oil) were administrated to patients for the period of twelve weeks. Improvements of DAS28-ESR were also evaluated according to the European League against Rheumatism response criteria and percentage improvement of clinical parameters in Rheumatoid Arthritis patients. Improvements in DAS28-ESR and Clinical Parameters criteria were compared by Woolf statistical test, Cohen's Kappa (𝜅) statistic for agreement and linear regression analysis. Classification of improvement in DAS28-ESR and clinical parameters among on the demographical characteristics and RA-Factor were generally identical (p-value >0.05) except patients’ nature of work (p-value <0.05). Simple linear regression analysis showed a significant correlation between improvement between DAS28-ESR and clinical parameters (R² = 0.64; p-value <0.001). The Cohen's Kappa (𝜅) coefficient (95% CI) between of them was 0.43 (0.21 to 0.66), indicating good agreement (p-value <0.001). This study concluded that improvements in Disease Activity Score 28 (DAS28) using erythrocyte sedimentation rate (DAS28-ESR) and Clinical Parameters are same in cases of Rheumatoid Arthritis.