Disease Activity Score 28 (DAS28)
Quantifies rheumatoid arthritis disease activity to guide DMARD therapy escalation and treat-to-target management
- Highest activation tier
- Mandatory
- How it is scored
- Scored in code; a detected disagreeing draft value is flagged for correction
- Scoring type
- formula
- Care settings
- Inpatient, Outpatient
When it activates
Scribeable activates a calculator from the encounter. The Disease Activity Score 28 (DAS28) can activate when the transcript or pasted chart context documents any of these:
- Rheumatoid arthritis disease activity assessment
- DMARD therapy response evaluation
- RA treatment escalation decision
- Biologic therapy candidacy
- RA remission assessment
A coded diagnosis can also activate it. ICD-10 prefixes carried by the registry: M05, M06.
Note-type scope: it activates on notes whose subject resolves to rheumatology. A note that resolves to another subject does not carry it even when the clinician's specialty matches; a note with no resolvable subject (a generic consultation) falls back to the specialty match.
Inputs the note needs
4 inputs. Each is resolved from the transcript, the pasted chart context and charted labs; an input marked "asks you" is requested as a clarification when it is undocumented.
| Input | Type | Unit / options | Guidance |
|---|---|---|---|
| Number of tender joints out of 28 assessed | exam | ||
| Number of swollen joints out of 28 assessed | exam | ||
| Erythrocyte sedimentation rate (mm/hr) | lab | mm/hr | |
| Patient global assessment of disease activity (0-100mm VAS) | symptom |
Scoring
DAS28-ESR = 0.56 x sqrt(tender28) + 0.28 x sqrt(swollen28) + 0.70 x ln(ESR) + 0.014 x patient_global. DAS28-CRP variant: 0.56 x sqrt(tender28) + 0.28 x sqrt(swollen28) + 0.36 x ln(CRP+1) + 0.014 x patient_global + 0.96.
DAS28-ESR = 0.56 × √Number of tender joints out of 28 assessed + 0.28 × √Number of swollen joints out of 28 assessed + 0.70 × ln(Erythrocyte sedimentation rate (mm/hr)) + 0.014 × Patient global assessment of disease activity (0-100mm VAS)
Interpretation
<2.6: Remission — maintain current therapy, consider cautious taper. 2.6-3.2: Low disease activity — acceptable if remission not achievable. >3.2-5.1: Moderate activity — escalate therapy (add/switch DMARD, consider biologic). >5.1: High disease activity — aggressive therapy change required. Treat-to-target: aim for remission (DAS28 <2.6) or low disease activity within 6 months.
Evidence
Sources carried in Scribeable's citation registry for this calculator; guideline version: van der Heijde 1990.
- van der Heijde DM et al. Judging disease activity in clinical practice in rheumatoid arthritis (DAS28)van der Heijde et al. (DAS28) 1990 · 1990 · Level I · link last verified 2026-03-28
How Scribeable handles it in the note
When an encounter activates the Disease Activity Score 28 (DAS28) at the mandatory tier, Scribeable resolves its inputs from the transcript, the pasted chart context and any charted labs, and asks you for a missing input you can supply before the note is finalised. Bedside-exam and separately ordered study values are not requested one input at a time; a calculator that carries a combined clarification question may still put that single question to you.
The score is computed in code from the resolved inputs, not recalled by the language model. If the draft states a Disease Activity Score 28 (DAS28) value that disagrees with the computed one, the disagreement is flagged to the second drafting pass, which is instructed to correct the score and its interpretation before you see the note.
Classified as a risk score: activated strictly, by a documented trigger, never by a permissive reading of the encounter.
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