Article Text

AB0436 Patient acceptable symptom state in rheumatoid arthritis patients starting methotrexate correlates with age and patient reported outcomes
  1. S.M. Verstappen,
  2. M. Lunt,
  3. A. Barton,
  4. J. Anderson,
  5. K. Hadfield,
  6. K.L. Hyrich
  7. and RAMS Co-investigators
  1. Arthritis Research UK Epidemiology Unit, The University of Manchester, Manchester, United Kingdom


Background The patient acceptable symptom state (PASS) is a patient reported outcome used to identify the health state patients find acceptable or satisfactory. Limited data is available about the contribution of demographic, disease and patient measures indicating a satisfactory health state according to the patient.

Objectives To determine the association between demographic and clinical variables with a satisfactory patient rated health state.

Methods Consecutive patients from the Rheumatoid Arthritis Medication Study (RAMS) were included. RAMS is a national multi-centre observational study including patients with rheumatoid arthritis or undifferentiated arthritis who are starting methotrexate (MTX) for the first time. Patients were clinically assessed by a research nurse at time of MTX start (baseline). Patients (n=163) recruited to date with complete baseline data including PASS, pain (100mm VAS), fatigue (100mm VAS), physician global assessment (100mm VAS), DAS28, HAQ-score and quality of life (Qol, EQ-5D) were included in this study. PASS was formulated as ”Is your current condition satisfactory, when you take your general functioning and your current pain into consideration” (yes/no). First, univariate logistic regression analyses were applied to determine the association between each of the demographic and clinical variables with PASS separately. Data are presented as odds ratios (OR, 95%CI) per change in SD. Secondly, forward stepwise logistic regression was performed (pe=0.2 and pr=0.1) and subsequently the total contribution of all variables included in the final model was calculated (AUC).

Results Median [IQR] age was 59 [46 – 67] yrs and median symptom duration was 12 [4 – 29] months; 111 (68%) patients were female. Sixty-six (40%) responded that they were satisfied with their condition. Satisfied patients were compared to unsatisfied patients (median; OR 95%CI): those satisfied with their health state were more likely to be older (62 vs 56; 1.59, 1.13 to 2.25) and less likely to be women (34% vs 66%; 0.45, 0.23 to 0.87). In addition, all disease related measures were significantly better in patients who were satisfied compared to those who were not: VAS pain (30 vs 66; OR 0.23, 95%CI 0.15 to 0.37), VAS fatigue (33 vs 67; OR 0.27, 95%CI 0.17 to 0.41), VAS physician (29 vs 57, OR 0.33, 95%CI 0.22 to 0.50), Qol (0.727 vs 0.516, OR 4.76, 95%CI 2.54 to 8.91), HAQ-score (0.56 vs 1.63; OR 0.29, 95%CI 0.19 to 0.44) and DAS28 (4.4 vs 5.6, OR 0.41, 95%CI 0.27 to 0.60). Symptom duration was the only variable not statistically significant. In the final model the strongest predictor of a satisfactory health state was VAS pain (<0.001, z=-4.06) followed by HAQ-score (p=0.26, z=-3.85) and age (p=0.016, z=2.41). The overall AUC was 0.885.

Conclusions In this cohort of patients starting MTX for the first time, forty percent found their health state satisfactory. Patient reported outcomes and older age mainly explain fulfilment of this state, with many still having moderate levels of disease activity.

Disclosure of Interest None Declared

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