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The DAS28-4 is normally a composite index of four weighted variables: the number of tender joints among 28 specific joints examined; the number of swollen joints among the same 28 joints; the erythrocyte sedimentation rate ; and the patient’s global assessment of disease activity, assessed by using a visual-analogue scale ranging from 0 to 100. The amount of disease activity is known as to be low if the DAS28-4 is certainly 3.2 or less, moderate if the score is greater than 3.2 to 5.1, and high if the score is higher than 5.1. A score of less than 2.6 indicates that the individual is in remission according to these requirements.10-12 The erythrocyte sedimentation rate was measured in the neighborhood study sites, with the procedure assignments of the patients concealed from the analysis investigators and the sponsor.