The Patient Acceptable Symptom State (PASS) in Asian rheumatoid arthritis (RA) patients

Abstract

Background/purpose: The level of acceptability of the disease status, the PASS, is an important patient-reported outcome measure (PROM) in RA, not evaluated in Asians. The objective is to evaluate the characteristics of the PASS and its corresponding cut-offs for clinical outcomes and PROMs in multiethnic Asians with RA. Methods: RA patients in a randomised controlled trial evaluating multidisciplinary care in a tertiary academic centre in Singapore. Clinical measures included (i) disease activity: Disease Activity Score (DAS28-ESR), Clinical Disease Activity Index (CDAI), (ii) PROMs on a 0-10 scale (10 being the worst) for pain, coping, patient global disease assessment (PGA), and (iii) quality of life (QOL): modified Health Assessment Questionnaire (mHAQ) and Euro-QOL 5-Dimension 3-level (EQ5D). Cut-off values of the PASS were estimated using the 75th percentile of the cumulative distribution for each measure rated as PASS positive. Multivariate logistic regression evaluated predictors of PASS. Results: 131 patients (86.3% female, 53.4% Chinese, age 54.4 ± 12.7 years) were included. Median (IQR) disease duration was 5.5 (2.4, 11.0) years, DAS28 was 2.90 (2.24, 3.65) and CDAIwas 5.0 (2.0, 10.0). Median mHAQ was 0 (0, 0.25) and mean EQ5D was 0.74 ± 0.28. 110 (84%) patients were in PASS and had lower disease activity, patient reported symptom levels and better QOL (P < 0.001). 62.5% were either in DAS28 remission or low disease activity. PASS cut-off for DAS28 was 3.50, CDAI was 6.5, mHAQ was 0.13, and EQ5D was 0.85. For PROMs, cut-off for pain was 3.5, PGA was 3.0 and coping was 4.5. in multivariate analysis, poorer levels of coping and higher disease activity (CDAI) negatively predicted being in PASS, with OR 0.87 (95%CI 0.76–0.99, P = 0.028) and OR 0.91 (95%CI 0.86–0.97, P = 0.002) respectively. Conclusion: PASS is a valid tool for Asian RA patients, with cut-offs consistent with the literature (3.0–4.5) for PROMs on VAS. Disease activity and levels of coping were good predictors of PASS.