Complete and acceptable symptom remission in rheumatoid arthritis: PASS-based thresholds derived from the Okomarigoto...

Residual symptoms frequently persist despite clinical remission in RA. Although complete absence of residual symptoms is associated with favorable outcomes, an acceptable level of residual symptoms has not been defined. This study aimed to establish clinically meaningful thresholds for residual symptoms assessed by the Okomarigoto Sheet (OS) and to evaluate their clinical validity using the Patient Acceptable Symptom State (PASS).

This cross-sectional study included 370 patients with RA, including 213 who achieved Simplified Disease Activity Index (SDAI) remission. Residual symptoms were assessed using the OS, and PASS was used as an external anchor. OS thresholds were determined using the 75th percentile method and evaluated by Receiver Operator Characteristic (ROC) analysis. Clinical validity was assessed by the proportion of patients reporting PASS, Health Assessment Questionnaire-Disability Index (HAQ-DI), and patient global assessment (PGA).

Among 370 patients, 284 reported PASS. The 75th percentile method identified OS thresholds of 3 in the overall cohort and 2 among patients achieving SDAI remission. ROC analysis demonstrated good discrimination for patients reporting PASS (AUC 0.824 and 0.838, respectively). The proportion of patients reporting PASS decreased across increasing OS categories in both the overall cohort (95.2%, 83.9% and 46.8%; P < 0.0001) and the SDAI remission subgroup (99.0%, 95.7% and 71.4%; P < 0.0001). Lower OS scores were also associated with better physical function and lower PGA scores.

OS-defined symptom remission provides a clinically meaningful framework for evaluating acceptable residual symptom burden in RA. Assessment with the OS may complement conventional remission criteria and support more patient-centred treatment strategies.