and validation in a prospective longitudinal study of patients with rheumatoid arthritis [see comments]. Arthritis Rheum 1995;38:44–8. Consistency in assessing the

clinical practice With the increasing availability of biological therapies for patients with rheumatoid arthritis (RA), the need to include reliable and reproducible clinical measures of disease activity in routine practice has been emphasised.1 Disease Activity Score-28 (DAS28) is validated for use in clinical trials;2–5 however, it is not known how it performs in a clinical setting. The aim of this study was to evaluate consistency in the measurement of DAS28, and its individual components, by clinic staff in one centre with different levels of experience. Twelve patients with RA (six per exercise) were assessed for the inter-observer exercises. Five patients were assessed for the intra-observer exercise. Six members of the rheumatology team (two staff rheumatologists, two trainees in rheumatology, one advanced nurse practitioner and one rheumatology nurse specialist) participated in the study. Before each DAS28 reproducibility exercise, the EULAR guidelines for the assessment of swollen and tender joints were reviewed. Patients scored a general health assessment (GHA) once only and the erythrocyte sedimentation rate (ESR) was taken within 48 hours. For intra-observer assessment, one trainee (CAEW) assessed five patients at the same time on three consecutive days. Patients scored a GHA daily. ESR was taken at one time-point only. Single measure (sICC) and average measure (aICC) intraclass correlation coefficients were used to calculate inter-observer reliability. Pearson correlations were used to calculate the intra-observer agreement between joint scores and DAS28 over 3 days. Swollen joint counts (SJCs) obtained by the assessors in exercise 1 produced a sICC of 0.29 (95 % confidence interval (CI), 0.02 to 0.08) and aICC 0.71 (95 % CI, 0.10 to 0.95