The most commonly used score in clinics is the DAS28 score. ‘D. A. S.’ stands for ‘disease activity score’ whilst the 28 relates to the number of joints examined. It is made up of 4 components including a tender joint count, a swollen joint count, a blood test measuring inflammation – CRP or ESR – and the patients’ assessment of their health over the last week. Other disease activity scores such as the CDAI, or clinical disease activity score, do not include blood tests.

The 28 joints included in disease activity scores are the shoulders, elbows, wrists, knuckles, middle joints on the fingers, and the knees. It’s not that the other joints aren’t important, especially from a patient viewpoint, just that they are not included in the measure.

People with arthritis often ask why the DAS28 does not include the feet. Research found that the overall score did not differ between using 28 joints and a greater number of joints, including the feet. This is why the feet are not included in the measure. The 28 joint count has since become the standard measure used to assess disease activity in people with arthritis, and in clinical trials. However, the feet are often affected in rheumatoid arthritis, and it is therefore really important that people with arthritis and their clinicians discuss and assess the feet, to make sure that inflammation, and other problems are addressed. If you have problems with your feet please raise them with your rheumatology team.

Joints might appear swollen for lots of reasons. In rheumatoid arthritis, healthcare professionals are looking for joint swelling caused by inflamed joint lining. This makes the joints feel soft and squidgy, like a grape. It is really important that only those joints which feel soft and squidgy are counted as swollen. This kind of swelling can last a long time, or can come and go quite quickly.

Joints can be swollen for other reasons apart from joint inflammation. Osteoarthritis is quite often present alongside rheumatoid arthritis. Osteoarthritic joints are very hard and bony, and don’t tend to change quickly. Although it will look swollen and can be tender to touch, this swelling is caused by bone, so will feel hard and not squidgy. These hard bony swellings do not count as a swollen joint.

There are other structures around the joints which might make you think they are swollen, when they are not. Swelling outside the joint can include pockets of fluid called bursitis. Bursitis does not count as a swollen joint.

Some people have rheumatoid nodules which are knobbly swellings attached to the skin. Nodules do not count as swollen joints.

The only type of swelling that counts in rheumatoid arthritis disease activity examinations is boggy swelling that feels like a grape, due to inflammation in the joint. In this picture, the knuckle joints are swollen.

Healthcare professionals use the word tender to describe joints that feel painful, or sore. Joints may be tender and swollen, just swollen, or just tender.

You need to press on the joint either until it hurts, or until your fingernails go white. If your joint is tender to touch you don’t need to press any harder, but you will still need to feel for swelling.

When examining the joint, you need for feel for the joint line which is where the ends of the two bones meet – this is where you will be able to feel swelling, if there is any. The video goes through each joint and explains where the joint line is and how the patient can find it.

This will become easier with time. Feeling where the bones move will help you determine whether you are in the right place.

Swelling can occur in places other than the joints, including the palms and the back of the hands. This is important to pay attention to, but does not count as swelling in disease activity scores.

Although rheumatoid arthritis is often described as being symmetrical, it is very common for different sides of the body to be affected differently.

Nodules often stay for a long time. Sometimes they respond to medical treatment and may shrink, or go away.