OBJECTIVES: To investigate the influence of age and gender on the components of 
the 28-joint Disease Activity Score (DAS28) in patients with rheumatoid 
arthritis (RA), and to clarify whether a high DAS28 can be equally interpreted 
in all age groups, independent of gender.
METHODS: A prospective cohort of 553 patients with RA was studied for 
approximately 20 years after diagnosis. The single measures of disease activity 
and the share of different components of the DAS28 (eg, erythrocyte 
sedimentation rate; ESR) were analysed and compared between three age groups 
(<45, 45-65 and >65 years) and per gender, using analysis of variance (ANOVA). 
The performance of the DAS28 and its components was explored in moderate to high 
and low DAS28 categories. Linear mixed model analysis was used to design the 
models best predicting ESR and the share of ESR.
RESULTS: ESR significantly increased with age, independent of other variables of 
disease activity. This increase was more pronounced in male than in female 
patients. Nevertheless, the share of ESR increased with age only in male 
patients with a low DAS28 (<3.2). If the DAS28 score was >3.2, age and gender 
did not have a significant effect on any components of the DAS28. C-reactive 
protein (CRP) and DAS28(CRP) were not influenced by age.
CONCLUSIONS: A high DAS28 was found to perform equally in all age groups, in men 
and women, despite the elevating effect of age on ESR. In elderly men with low 
disease activity, remission rate could be underestimated by an elevated ESR.