Attainment of the Patient-acceptable Symptom State in 548 patients with rheumatoid arthritis: Influence of demographic factors - 09/10/20

Doi : 10.1016/j.jbspin.2020.09.003

Catia Duarte ^a,^b,⁎ , Eduardo Santos ^a,^c,^d, Tore Kristian Kvien ^e, Maxime Dougados ^f, Maarten de Wit ^g, Laure Gossec ^h,^i,^{^{1
LG and JAPS had equal contributions in this paper.}}, José António Pereira da Silva ^a,^b,^{^{1
LG and JAPS had equal contributions in this paper.}}
^a Department of Rheumatology - Centro Hospitalar e Universitário de Coimbra, Coimbra, Praceta, R. Prof. Mota Pinto, 3004-561 Coimbra, Portugal
^b Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba Celas, 3000-548 Coimbra, Portugal
^c Abel Salazar Institute of Biomedical Sciences, University of Porto, R. Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
^d Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Polo C, Avenida Bissaya Barreto, 3046-851 Coimbra, Portugal
^e Department of Rheumatology, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, NoruegaOslo, Norway
^f Rheumatology B, Cochin Hospital, Paris Descartes University, 12, rue de l’École de Médecine, 75006 Paris, France
^g Patient Research Partner, Netherlands
^h Sorbonne Université, inserm, Institut Pierre-Louis d’Epidémiologie et de Santé Publique, 56, boulevard Vincent-Auriol, 75646 Paris, France
ⁱ Pitié Salpêtrière Hospital, AP–HP, Rheumatology Department, 47-83, boulevard de l’Hôpital, 75013 Paris, France

^⁎Corresponding author at: Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-004 Coimbra, Portugal.Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Mota PintoCoimbra3000-004Portugal

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Highlights

•	In Rheumatoid Arthritis (RA) disease activity, pain and emotional well-being were independently associated with being in patient acceptable symptom status (PASS).
•	Among patients in inflammatory remission, being in PASS was more frequent among older patients and residents in countries with lower Gross Domestic Product per capita.
•	PASS status is related to many factors beyond disease activity, which deserve careful consideration when devising management strategies.

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Abstract

Objectives

To explore the clinical and socio-demographic factors associated with Patient Acceptable Symptom Status (PASS) in Rheumatoid Arthritis (RA).

Methods

In a post-hoc analyses of a cross-sectional study, RA patients from 11 countries were included. PASS was assessed as acceptable/not acceptable status by the patient. Variables collected included socio-economic (gender, age and country gross domestic product (GDP) per capita) and clinical variables: DAS28-3vESR (28 joint counts and Erythrocyte Sedimentation Rate), the patient-reported Rheumatoid Arthritis Impact of Disease (RAID) score and its seven domains (scored 0 to 10). Patients in PASS or not were compared through univariable tests and factors associated with PASS assessed by multivariable forward conditional logistic regression. A similar analysis was performed in the subgroup patients in DAS28 remission (n=168).

Results

A total of 548 patients were included: 80.5% female, mean (±SD) age 55.8±12.8years, disease duration 13.6±10.6 years, DAS28 3.6±1.5. Overall, 360 (65.7%) considered themselves to be in PASS. Independent factors positively associated with being in PASS were age>50 years [odds ratio, OR 1.67; (95% confidence Interval: 1.04–2.67)], a lower DAS28 [OR: 1.28 (1.08–1.52)], lower pain [OR:1.45 (1.27–1.64)] and better emotional well-being [OR:1.28 (1.13–1.45)]. Among patients in remission, being in PASS was positively associated with less severe pain [OR: 2.50 (1.79–3.84)], age>50 years [OR 3.30 (1.03 to10.87)] and living in a country of the low GDP category [OR: 5.08; (1.34–19.23)].