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Attainment of the Patient-acceptable Symptom State in 548 patients with rheumatoid arthritis: influence of demographic factors

Author

Joint Bone Spine. 2020 Sep 10;S1297-319X(20)30156-1. doi: 10.1016/j.jbspin.2020.09.003.Online ahead of print.

Catia Duarte 1, Eduardo Santos 2, Tore K Kvien 3, Maxime Dougados 4, Maarten de Wit 5, Laure Gossec 6, J A P da Silva 7

Author Information

1 Department of Rheumatology - Centro Hospitalar e Universitário de Coimbra, Coimbra, Praceta, R. Prof. Mota Pinto, 3004-561 Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba Celas, 3000-548 Coimbra, Portugal. Electronic address: ucf.rc16@gmail.com.

2 Department of Rheumatology - Centro Hospitalar e Universitário de Coimbra, Coimbra, Praceta, R. Prof. Mota Pinto, 3004-561 Coimbra, Portugal; Abel Salazar Institute of Biomedical Sciences, University of Porto, R. Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal; Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Polo C, Avenida Bissaya Barreto, 3046-851 Coimbra, Portugal.

3 Department of Rheumatology, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, NoruegaOslo, Norway.

4 Rheumatology B, Cochin Hospital, Paris Descartes University, 12 Rue de l'École de Médecine, 75006 Paris, France.

5 Patient Research Partner, Netherlands.

6 Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 56 Boulevard Vincent Auriol, 75646 Paris, France; Pitié Salpêtrière Hospital, AP-HP, Rheumatology Department, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.

7 Department of Rheumatology - Centro Hospitalar e Universitário de Coimbra, Coimbra, Praceta, R. Prof. Mota Pinto, 3004-561 Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba Celas, 3000-548 Coimbra, Portugal.

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±12.8 years, 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]).

Conclusions: Being in PASS is related to many factors besides disease activity, including age, perceived impact of the disease and national GDP.