The acute phase reactants (CRP level and ESR) weigh heavily in the DAS28 calculation, which may erroneously lower the DAS28 score in the face of objective evidence of ongoing disease activity in the joints [37], especially since a significant proportion of patients with RA can have a normal ESR and normal level of CRP at presentation [38] including some patients with radiographic evidence of progressive erosive disease [39]. Here, CRP is linked to rheumatoid arthritis.