DAS28 form - DAS-score
DAS28 form
Patient name ……………………………………………. Date of Birth ____-____-______
Observer name …………………………………………… Date ____-____-______
| |Left | |Right | |
| |Swollen |Tender |Swollen |Tender |
|Shoulder | | | | |
|Elbow | | | | |
|Wrist | | | | |
|MCP |1 | | | | |
| |2 | | | | |
| |3 | | | | |
| |4 | | | | |
| |5 | | | | |
|PIP |1 | | | | |
| |2 | | | | |
| |3 | | | | |
| |4 | | | | |
| |5 | | | | |
|Knee | | | | |
|Subtotal | | | | |
|Total |Swollen | |Tender | |
How active was your arthritis during the past week?
(Please mark the degree of activity on the scale below by placing a vertical line | )
|Swollen Joint Count (0-28) | |
|Tender Joint Count (0-28) | |
|ESR | |
|VAS disease activity (0-100mm) | |
| | |
|DAS28 = 0.56*((t28) + 0.28*((sw28) + 0.70*Ln(ESR) + 0.014*VAS | |
|For free online calculator visit das28.nl | |
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