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Abstract
ObjectivesTo describe outcomes of patients with early RA in a patient acceptable symptom state (PASS) at treatment initiation and to identify clusters of symptoms associated with poor outcomes.MethodsData came from the Rheumatoid Arthritis Medication Study, a UK multicentre cohort study of RA patients starting MTX. The HAQ, DAS28 and other patient-reported outcome measures (PROMs) were collected at baseline, and at 6 and 12 months. Patients answering yes to the question ‘Is your current condition satisfactory, when you take your general functioning and your current pain into consideration?’ were defined as PASS; patients answering no were defined as N-PASS. Symptom clusters in the baseline PASS group were identified using K-medians cluster analysis. Outcomes of baseline PASS vs N-PASS patients and each cluster are compared using random effects models.ResultsOf 1127 patients, 572 (50.8%) reported being in PASS at baseline. Over one year, baseline PASS patients had lower DAS28 (mean difference = −0.71, 95% CI −0.83, −0.59) and HAQ scores (mean difference = −0.48, 95% CI −0.56, −0.41) compared with N-PASS patients. Within the baseline PASS group, we identified six symptom clusters. Clusters characterized by high disease activity and high PROMs, or moderate disease activity and high PROMs, had the worst outcomes compared with the other clusters.ConclusionDespite reporting their condition as ‘satisfactory’, early RA patients with high PROM scores are less likely to respond to therapy. This group may require increased vigilance to optimize outcomes.
Highlights
Objectives of disease management for patients with RA include achieving remission, reducing disability and Submitted 22 May 2019; accepted 26 August 2019In previous studies, patients rated moderate levels of disease activity as acceptable
Patients in patient acceptable symptom state (PASS) were older than not in PASS (N-PASS) patients at baseline [median (IQR) age: PASS 1⁄4 63 (51, 70) years; N-PASS 1⁄4 59 (49, 68) years, P 1⁄4 0.0002] and the PASS group had a lower proportion of women than the N-PASS group [N (%) women: PASS 1⁄4 343 (60.0); N-PASS 1⁄4 371 (66.9), P 1⁄4 0.017]
Multivariable analysis indicated that the baseline variables independently associated with increased odds of being in PASS at baseline were: older age [odds ratio (OR) per year increase 1.01], shorter disease duration [OR per Baseline scores, median (IQR)
Summary
Objectives of disease management for patients with RA include achieving remission, reducing disability and Submitted 22 May 2019; accepted 26 August 2019In previous studies, patients rated moderate levels of disease activity as acceptable. Despite these moderate levels of disease activity and disability, patients in PASS had lower levels of pain and reported being able to cope with their condition better than patients not in PASS (N-PASS). This was confirmed in a cross-sectional study across 10 European countries where both higher pain and coping scores were associated with reduced odds of being in PASS [pain odds ratio (OR) 1⁄4 0.80, 95% CI 0.67, 0.96; coping OR 1⁄4 0.84, 95% CI 0.71, 0.97] [7]
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