0:03
Hello, my name is Mini Day. I am a rheumatology and internal medicine fellow from London in the UK and I'm delighted to be reporting for RheumNow here in sunny Orlando for ACR 2026.
0:16
So, a question for you. If a patient with rheumatoid arthritis still has a high disease activity score, does that necessarily mean they need more immunosuppression?
0:28
What would you do? Abstract 288 looks at that exact question by defining a state of low inflammatory activity.
0:39
So in this particular abstract, the researchers used a modified version of the DAS28, the SDAI and the CDAI that excludes tender joint count and the patient's global assessment.
0:55
They analyzed three trials involving 960 patients alongside a prospective cohort of more than 3,400 individuals.
1:02
The proposed thresholds were below 1.4 for the modified DAS28, three or less for modified SDAI, and two or less for the modified CDAI.
1:11
So those are the thresholds for the modified scores and not the usual scores that we would calculate in clinic.
1:17
In the cohort, 44% met the modified DAS28 target compared with 32% in the conventional DAS28 cohort.
1:28
Despite identifying more patients, the new target was associated with similarly low levels of X-ray progression.
1:35
Patients who met it but still had high conventional scores more often had conditions such as osteoarthritis and mood disorders.
1:43
So the question is what the score is actually telling us.
1:48
So when assessing disease activity, if pain and tenderness remain high but there is little swelling, we would assess for ongoing inflammation and look for other explanations before changing treatment.
2:00
Ultrasound can also help when the clinical picture is uncertain.
2:06
However, we must also acknowledge and address the pain symptoms.
2:09
So sometimes someone can have low inflammatory activity but still be struggling with pain, fatigue and disability and other really quite troubling symptoms.
2:21
Those need separate assessment and a treatment plan as well.
2:27
These modified targets could help us separate the decision to escalate immunosuppression from the wider task of helping someone feel and function better.
2:37
Before changing a DMARD, we therefore need to understand what is driving the patient's symptoms.
2:41
And that's what this abstract is helping us to understand better.
2:46
If you'd like to know more about that particular abstract, it's 2808.
2:52
And for more coverage from ACR 2026, don't forget to follow RheumNow. Thank you.
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