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Table 3 Strategies to Manipulate the DAS28 Assessment Reported by the Sample

From: Factors that influence rheumatologists’ anti-tumor necrosis factor alpha prescribing decisions: a qualitative study

Number Strategy to Manipulate the DAS28 Assessment
1 Measure disease activity using a different instrument (such as RAPID3) and convert to DAS28 scores.
2 Claim the patient has psoriatic arthritis because fewer active joints are required to prescribe anti-TNF therapy compared with RA.
3 Only perform one DAS28 assessment.
4 Stop a patient’s steroids to increase their DAS28 score.
5 Perform a DAS28 assessment when the patient has a flare in disease activity.
6 Increase the frequency of DAS28 assessments to increase the likelihood of measuring two scores greater than 5.1.
  1. Note: The criteria by NICE to determine eligibility for anti-TNF therapy was to have two DAS28 assessments of at least 5.1 one month apart [34]. DAS28: Disease Activity Score-28 Joints; RAPID3: Routine Assessment of Patient Index Data 3