SAT0654 SHOULD PATIENTS WITH RHEUMATOID ARTHRITIS (RA) ASK FOR A BETTER DEAL THAN MERELY AN ACCEPTABLE SYMPTOM STATE? AN ANALYSIS OF 1931 RA PATIENTS
Authors: Catia Duarte, José Antonio P. Da Silva, Eduardo Santos, Eirik Kristianslund, Maarten de Wit, Maxime Dougados, Tore K. Kvien, Laure Gossec, Turid Heiberg
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Patients satisfaction with their symptoms state may be considered an acceptable outcome in RA. However, many patients who report being in an Acceptable Symptom State (PASS) have still moderate disease activity.<sup>1</sup> <h3>Objectives</h3> To explore whether it is possible to identify more stringent levels of symptom states in patients’ perspective. <h3>Methods</h3> A cross-sectional analysis of unselected adult patients with the diagnosis of RA from the RA Impact of Disease (RAID) validation study<sup>2</sup> (n=570, from 12 European countries), and from the Norwegian DMARD (NOR-DMARD)<sup>3</sup> registry (n=1372), was performed. Symptom state was calculated using the anchored method based on the patients’ perspective, taking, as gold standard, the question: “<i>Think about all the ways your rheumatoid arthritis has affected you during the last week. If you were to remain for the next few months as you were during the last week, how would you consider this state</i>?”, with five levels: Very bad/Bad/Acceptable/Good/Very good. Disease activity was assessed based on the DAS28-3v (joint counts and ESR). Impact was evaluated through the seven patient-reported domains included in the RAID score. The threshold levels of DAS28-3v, Individual RAID items and RAID score for Acceptable/Good/Very Good States were calculated using the receiver-operating characteristic (ROC) curve and the optimal cut-off was determined through Youden Index. <h3>Results</h3> Data from 1931 patients [74.5% female, mean (SD) age 54.4 (14.1) years, mean disease duration 13.8 (10.4) years, mean DAS 28-3v-ESR 3.0 (1.4)] were analysed. In all, 14.5% considered themselves as being in a “very good”, 21% as “good” and 33.1% in a “acceptable” status. Disease activity, RAID global score and all individual seven domains of RAID were significantly different between patients across these 3 symptom states (p&lt;0.001). Patients reporting a “Very Good” symptom status had disease activity in the range of remission (mean DAS28-3v-ESR: 1.99±0.91), while patients in “acceptable” status were in range of low disease activity (DAS28-3v-ESR:2.98±1.20) and in moderate disease activity in patients with “Bad” (DAS28-3v-ESR: 3.83±1.44) and “Very Bad status” (DAS28-3v-ESR: 4.10±1.59). Remission according the Boolean ACR/EULAR criteria was observed in 70.9% of patients in “Very Good” symptom status (versus 28% in “Good”, 5% in “Acceptable” and inferior to 1% in “Bad” and “Very Bad” symptom status). The cut-off value for “Very Good” states was 0 for most individual RAID items, except for pain and fatigue ≤1 (Figure1). <h3>Conclusion</h3> Being in a “very good” symptom status showed a good correspondence to being in remission and having very low disease impact. This shows promising in identifying a status that patients would actually desire, more than accept for, while corresponding to a level of disease activity consistent with the long-term preservation of structure and function. <h3>References</h3> [1] ) Heiberg T, et al. Ann Rheum Dis. 2008 Jul;67(7):967-71 [2] Gossec L, et al. Annals of the rheumatic diseases. 2011;70(6):935-42 [3] Kvien TK, et al. Clin Exp Rheumatol. 2005. 23: S188-94 <h3>Acknowledgement</h3> Carmona L, Dijkmans BA, Englbrecht M, Gogus F, Cerinic MM, Otsa K, Sokka T, Balanescu A <h3>Disclosure of Interests</h3> Catia Duarte: None declared, José Antonio P. da Silva: None declared, Eduardo Santos: None declared, Eirik kristianslund: None declared, Maarten de Wit: None declared, maxime dougados Grant/research support from: Eli Lilly and Company, Pfizer, AbbVie, and UCB Pharma, Consultant for: Eli Lilly and Company, Pfizer, AbbVie, and UCB Pharma, Tore K. Kvien Grant/research support from: AbbVie, BMS, MSD, Pfizer, Roche and UCB., Consultant for: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Hospira, Merck-Serono, MSD, Novartis, Oktal, Orion Pharma, Pfizer, Roche, Sandoz, Sanofi, Mylan and UCB, Speakers bureau: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Hospira, Merck-Serono, MSD, Novartis, Oktal, Orion Pharma, Pfizer, Roche, Sandoz, Sanofi and UCB, Laure Gossec Grant/research support from: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis-Sandoz, Pfizer, Sanofi, and UCB, Consultant for: AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, MSD, Nordic Pharma, Novartis-Sandoz, Pfizer, Roche, Sanofi, and UCB, Consultant for: L Gossec has received honoraria from Celgene as investigator for this study, Turid Heiberg: None declared