Surreal illustration representing rheumatoid arthritis, featuring interconnected joints and cartilage matrix with glowing nodes indicating disease activity.

Unlocking RA Mysteries: Can Disease Activity Scores Predict Cartilage Damage?

Lena Voss in Health & Wellness June 2025 • 4 min read.

"New research from Indonesia explores the link between DAS28 and COMP levels in rheumatoid arthritis patients, offering insights into monitoring and managing this chronic condition."

Rheumatoid arthritis (RA) is a persistent autoimmune condition marked by symmetrical erosive arthritis in the synovial joints. This leads to pain, joint damage, impaired function, reduced quality of life, and even physical deformities. RA affects between 0.5% and 1.0% of the general population, with rates between 0.1% and 0.3% reported in Indonesia. Early diagnosis and treatment are vital for preventing joint deterioration.

Cartilage oligomeric matrix protein (COMP) has emerged as a promising biomarker to support RA diagnosis. COMP plays a role in assembling collagen type II fibers in cartilage and interacts with other matrix proteins to stabilize the collagen network. Previous research has suggested a correlation between serum COMP levels and the Disease Activity Score (DAS) 28-erythrocyte sedimentation rate (ESR) in the early stages of RA.

The Disease Activity Score (DAS) is essential for assessing RA stability, guiding treatment decisions to alleviate inflammation, and preventing further joint damage, which reduces pain and disability. Given the limited existing research on the relationship between DAS 28 and serum COMP levels, a study was conducted to investigate their correlation in RA patients.

Decoding the DAS28 and COMP Connection: What the Study Reveals

Surreal illustration representing rheumatoid arthritis, featuring interconnected joints and cartilage matrix with glowing nodes indicating disease activity.

A cross-sectional study was conducted with prospective data collection, involving patients from a rheumatology clinic at a government hospital in Bandung, Indonesia. Thirty RA patients and a control group were recruited through consecutive sampling after providing informed consent. The study was approved by the Health Research Ethics Committee of Dr. Hasan Sadikin Hospital, Indonesia.

The study's inclusion criteria focused on RA patients meeting specific clinical criteria based on the 2010 RA classification, as determined by rheumatologist examination without serology. Participants had to be over 18 years old and willing to participate by signing informed consent. Exclusion criteria included patients who were uncooperative, had a history of drug abuse or alcoholism, or had major medical disorders, such as diabetes, hypertension, liver or kidney disease, tuberculosis, or systemic lupus erythematosus.

DAS28 Assessment: Disease Activity Score 28 (DAS28) was calculated using the QxMD Software, integrating joint condition data, ESR, and subjective patient assessments.
Serum COMP Measurement: Blood samples were collected, and serum was separated and stored at -80°C. COMP levels were determined using the Human COMP/TSP5 enzyme-linked immunosorbent assay.
Statistical Analysis: The correlation between DAS28 and serum COMP levels was analyzed using IBM SPSS Statistics 23.

The study revealed that all patients experienced pain in the small joints of the hands, wrists, elbows, knees, and ankles, with worsened joint stiffness in the mornings and evenings. A significant number (16.67%) experienced hand deformities affecting hand function and grip strength. Most patients (86.67%) reported knee pain affecting their ability to walk. The average DAS28 value was 3.36±0.16, indicating moderate disease activity. However, the statistical analysis found no significant correlation between DAS28 and serum COMP levels (p=0.496 and rho=0.129).

The Implications: Why This Research Matters

This study found no direct correlation between DAS 28 scores and serum COMP levels in RA patients. This may be because DAS 28 calculations include ESR, which is not specific to RA inflammation and can be influenced by other inflammatory conditions. Further research is needed to identify more specific biomarkers for assessing disease activity and cartilage damage in RA, potentially improving treatment strategies and patient outcomes.

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Everything You Need To Know

What is DAS28, and why is it important in managing Rheumatoid Arthritis?

DAS28, or Disease Activity Score 28, is a crucial tool for evaluating the status of Rheumatoid Arthritis. It helps doctors make informed decisions about treatment to reduce inflammation and prevent further joint damage, which in turn alleviates pain and disability. This score integrates various factors, including the condition of 28 specific joints, ESR (erythrocyte sedimentation rate), and the patient's subjective assessment of their health. DAS28 is significant because it provides a standardized way to measure disease activity, allowing for consistent monitoring and adjustments to treatment plans. While DAS28 is widely used, it's important to note that it has limitations. For instance, the inclusion of ESR, a general marker of inflammation, can be influenced by other conditions, potentially affecting the accuracy of RA-specific assessments.

What is COMP, and how might it be useful in understanding Rheumatoid Arthritis?

COMP, or Cartilage Oligomeric Matrix Protein, is a biomarker that shows promise in the diagnosis and monitoring of Rheumatoid Arthritis. It is involved in the assembly of collagen type II fibers in cartilage and interacts with other matrix proteins to stabilize the collagen network. COMP's significance lies in its potential to provide insights into cartilage damage, which is a key feature of RA. Measuring serum COMP levels could help in assessing the severity of cartilage degradation and potentially guide treatment strategies aimed at preserving joint integrity. While COMP is a promising biomarker, research is ongoing to fully understand its correlation with disease activity and its role in predicting long-term outcomes in RA patients.

What did the study discover about the connection between DAS28 and COMP levels in RA patients?

The study investigated the relationship between DAS28 scores and serum COMP levels in Rheumatoid Arthritis patients. The main finding was that there was no direct correlation between DAS28 scores and serum COMP levels. This suggests that while DAS28 is useful for assessing overall disease activity, it may not directly reflect the extent of cartilage damage as indicated by COMP levels. The absence of a correlation could be because DAS28 includes ESR, which can be affected by other inflammatory conditions, making it less specific to RA-related cartilage degradation. This highlights the need for further research to identify more specific biomarkers that can accurately assess cartilage damage in RA.

Why is it important that DAS28 and COMP might not be directly related in Rheumatoid Arthritis?

The lack of correlation between DAS28 and serum COMP levels has important implications for how Rheumatoid Arthritis is monitored and treated. It suggests that relying solely on DAS28 may not provide a complete picture of disease progression, particularly in terms of cartilage damage. This underscores the need for a more comprehensive approach to assessment, potentially incorporating additional biomarkers or imaging techniques to evaluate joint health. By identifying more specific markers of cartilage damage, clinicians can better tailor treatment strategies to prevent joint deterioration and improve patient outcomes. This could lead to more targeted therapies that address both inflammation and cartilage protection.

What specific steps did the researchers take to ensure the accuracy of the study?

The study included several important factors to ensure the reliability and validity of the research. The participants were selected based on specific clinical criteria for Rheumatoid Arthritis, as determined by rheumatologist examination. Exclusion criteria were also in place to remove patients with conditions that could confound the results, such as drug abuse, alcoholism, or major medical disorders like diabetes, hypertension, or lupus. The study employed standardized methods for assessing DAS28 and measuring serum COMP levels, using validated assays and statistical analysis techniques. By adhering to these rigorous methodological standards, the study aimed to provide accurate and reliable insights into the relationship between disease activity and cartilage damage in RA.