Factors associated with and cutoff points for Patient Acceptable Symptom State (PASS) in rheumatoid arthritis

To identify factors associated with and cutoff points for patients' acceptance of symptom state in Thai patients with rheumatoid arthritis (RA).

Patients aged ≥ 18 years diagnosed with RA who were followed-up at the outpatient rheumatology clinics of Siriraj Hospital and Phramongkutklao Hospital during May 2017 to May 2019 responded to the Patient Acceptable Symptom State (PASS) questionnaire. The PASS questionnaire comprises three questions, including current PASS, future PASS (3 months), and lifelong PASS. Univariate (p < 0.2) and multivariate (p < 0.05) analyses were performed to identify factors significantly associated with PASS. Cutoff points of indices related to disease activity, functional status, and health-related quality of life (HRQoL) in patients with PASS were identified using the 75th percentile and receiver operating characteristic curve analysis based on optimal sensitivity and specificity.

From the 443 enrolled patients, 85%, 80%, and 84% considered themselves to be in current, future, and lifelong PASS, respectively. Step-wise backward multivariate analysis revealed disease duration, disease activity, functional status, cardiovascular comorbidities, and HRQoL to be independently associated with PASS. PASS cutoff points were identified, as follows: Disease Activity Score 28, 3.40-3.52; Health Assessment Questionnaire, 0.69-1; Patient Global Assessment of Disease Activity, 2.5-3; Physician Global Assessment of Disease Activity, 1-1.5; and EuroQoL-5 Dimensions, 0.83-0.86.

PASS was high in Thai patients with RA. Patients accepted their disease state at moderate disease activity and mild functional impairment. More shared decision-making and patient education should be incorporated into daily practice to improve patient outcomes.Key Points•Patients with RA accepted their disease state at moderate disease activity and mild functional impairment, while a "treat-to-target" strategy aiming at remission or low disease activity is recommended as a standard goal.•More shared decision-making and patient education should be incorporated into daily practice to improve outcomes.