SAT0653 PATIENT-ACCEPTABLE SYMPTOM STATUS IN RHEUMATOID ARTHRITIS: WEALTH AND AGE MATTER BEYOND DISEASE ACTIVITY AND IMPACT. AN ANALYSIS OF 548 PATIENTS

Abstract

Background: Patient Acceptable Symptom State (PASS) represents the maximum level of symptom intensity that patients consider acceptable1. Control of disease activity is associated to attainment of PASS1. Recognizing the factors associated with PASS status beyond disease activity, can be helpful in identifying the need for interventions beyond disease-modifying drugs, aimed at improving the satisfaction and well-being of patients with rheumatoid arthritis (RA). Objectives: To explore the clinical and socio-demographic factors associated with PASS status in RA. Methods: Data of patients with definite diagnosis of RA from 11 countries (post-hoc analyses of RAID Study2, with additional data from Portugal) were used. PASS was assessed using the anchored method based on patients’ perspective, through the question: “Think about all the ways your RA has affected you during the last week. If you were to remain for the next few months as you were during the last week, would this be a) Acceptable b) Unacceptable”. Variables analysed for differences across PASS status were (a) disease activity based on DAS28-3values (joint counts and ESR) categories, (b) impact by the seven patient-reported domains included in the RA Impact of Disease (RAID) score, (c) demographics: age (above or below 50) and gender, and (d) Country gross domestic product (GDP) classified as High GDP (>35.000 USD per capita) and Low GDP. Differences between patients in PASS or not were assessed through t-test for independent samples or Chi-square test, as adequate. Variables with p Results: In all, 548 patients (80.5% female, mean (SD) age 55.8 (12.8) years, mean (SD) disease duration 13.6 (10.6) years, mean (SD) DAS28-3v 3.6 (1.5), 44.2% in LDA or remission) from 11 European countries (5 (n=230) with high GDP and 6 (n= 318) with low-GDP) were analysed. The majority of patients (65.7%) considered themselves to be in PASS; among them 40% were in remission and 16.7% in LDA. In multivariate analyses, factors associated to being in PASS were lower disease activity (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]), older age (OR 1.67; [1.04-2.67]), but not GDP country category. When analysing PASS for patients in DAS28 remission independent predictors were lower pain (OR 2.5; [1.79 -3.45]), older age (OR 3.30 [1.03-10.82]) and living in a low GDP category country (OR: 5.0; [1.35-20.0]). Conclusion: PASS in RA is associated with lower inflammation, less symptoms and higher age, as expected. However, when analysing patients in DAS28 remission, thus taking out inflammation as a predictor, we found older age and living in a country with lower GDP were drivers of being in PASS. Thus, beyond disease activity and patient-reported impact, this observation underlines the potential effect of economical/cultural and personal aspects upon PASS, especially in the context of remission, suggesting the need for a holistic and personalized approach in the management of patients with RA.