FRI0654 Is the patient-acceptable status similar across 7 domains of health in patients with rheumatoid arthritis (RA)? post-hoc analyses from the validation in 549 patients of the rheumatoid arthritis impact of disease (RAID) score
Authors: C. Duarte, T. Kvien, J. A. Pereira da Silva, L. Gossec
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background:</h3> Patient Acceptable Symptom State (PASS) is the highest acceptable level of symptoms which patients consider satisfactory. In the Rheumatoid Arthritis Impact Disease (RAID) questionnaire, seven domains of health of importance for RA patients are collected.<sup>1</sup>. It is possible that levels judged acceptable by patients vary according to the domain of health. <h3>Objectives:</h3> To explore the relationship between seven RA domains of health (collected in the RAID) and PASS, and to define their PASS cut-off values. <h3>Methods:</h3> This is a <i>post-hoc</i> analysis of the cross-sectional study for RAID validation. Each of 7 domains (table 1) was evaluated through a Numeric Rating Scale from 0 (best) to 10 (worst). PASS was calculated using the anchored method based on patients’ perspective. Disease activity was assessed based on the DAS28–3 values (joint counts and ESR). Comparison of patients in PASS or not was assessed through Mann-Whitney or Chi-square test, as adequate. Variables with p&lt;0.05 were included in multivariate logistic regression (Forward Conditional) analysis. The thresholds of PASS for each domain was calculated using the receiver-operating characteristic (ROC) curve and the optimal cut-off was determined through Youden Index. 75th percentile analyses were also performed (not shown). <h3>Results:</h3> 549 patients [78% female, mean age 56.7 years, mean disease duration 12.3 years, mean (SD) DAS 28–3 2.7(1.2)] were analysed. The majority of patients (60.7%) considered themselves to be in PASS. Disease activity (DAS 28–3 mean 2.3 vs 3.4, p&lt;0.01) and all seven domains of health were significantly lower in patients in PASS versus not in PASS (p&lt;0.001). In multivariate analyses, lower disease activity (OR 0.72; 95%IC 0.56–0.92), lower pain (OR 0.75; 95% IC:0.65 -0.86) and better physical well-being (OR 0.74 95%; IC:0.65–0.85) were associated with being in PASS. The cut-off for PASS was ≤4.2 for the total RAID score but varied across the seven domains (table 1), with Pain (≤5) and Fatigue (≤5) having the highest acceptability cut-offs. Sleep Disturbance and Coping were the domains with lowest thresholds compatible with PASS (≤3). <h3>Conclusions:</h3> Pain and physical well-being appeared as major drivers of PASS. The cut-offs defining PASS were not the same for all RAID domains, indicating that being in PASS doesn’t mean the same acceptable severity for all domains of health. This observation suggests that individualised management, for each domain, should be considered. <h3>Reference</h3> 1) Gossec L, et al. Ann Rheum Dis2011;70:935–942. <h3>Acknowledgements:</h3> RAID Study Group: Balanescu A, Boumpas DT, Carmona L, de Wit M, Dijkmans BA, Dougados M, Englbrecht M, Gogus F, Heiberg T, Kirwan JR, Mola EM, Cerinic MM, Otsa K, Sokka T <h3>Disclosure of Interest:</h3> None declared