DAS28-ESR may underestimate disease activity in rheumatoid arthritis patients with nonalcoholic fatty liver disease: a retrospective cohort study
Authors' conclusion
Among patients with RA classified as having NAFLD, DAS28-ESR may underestimate disease activity compared with CRP-based or clinical indices.
Study context
- Population
- Rheumatoid arthritis (RA) patients in the Nagahama Riumachi Cohort, March 2017–August 2023; liver diseases other than nonalcoholic fatty liver disease (NAFLD) excluded
- Participants
- 349 patients
- Exposure
- RA with NAFLD vs RA without NAFLD
- NAFLDn = 73
- Non-NAFLDn = 276reference
- Outcome
- Clinical characteristics of RA patients with NAFLD, focusing on composite disease activity (CDAI, SDAI, DAS28-CRP, DAS28-ESR)
Methodological detailslogistic regression, linear mixed-effects models
- Logistic regression
- Linear mixed-effects models
Main finding
As reported in the abstract
Composite disease activity
- No significant differences between groups in disease activity by Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI) or DAS28-CRP
- NAFLD group had significantly lower DAS28-ESR and erythrocyte sedimentation rate (ESR) despite similar C-reactive protein (CRP)
Observational data: associations, not effects.
Further findings
Prevalence of NAFLD
Baseline characteristics
- NAFLD group younger, higher proportion of men, higher prevalence of body mass index (BMI) ≥ 25 kg/m²
Health Assessment Questionnaire Disability Index (HAQ-DI)
- HAQ-DI lower in NAFLD group, especially lower-limb domain
Factors associated with NAFLD (multivariable analysis)
- Younger age and higher BMI independently associated with NAFLD; ESR and HAQ-DI not significantly associated
ESR over follow-up (linear mixed-effects models)
- NAFLD not significantly associated with ESR, although ESR tended to be lower in NAFLD group
Original publication
DAS28-ESR may underestimate disease activity in rheumatoid arthritis patients with nonalcoholic fatty liver disease: a retrospective cohort study. Arthritis Res Ther. Published 8 July 2026. doi:10.
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