Article Text

Download PDFPDF

SAT0481 The relationship between the patient acceptable symptom state (PASS) and disease activity in patients with psoriatic arthritis (PSA)
  1. JZ Fei1,
  2. A Perruccio2,
  3. Y Ye1,
  4. DD Gladman1,
  5. V Chandran1
  1. 1Rheumatology
  2. 2Orthopaedics, Toronto Western Hospital, Universtiy of Toronto, Toronto, Canada


Background PASS is the highest level of symptoms beyond which patients consider themselves well. Psoriatic Arthritis Disease Activity Score (PASDAS) is a recently developed composite disease activity measure that summarizes a patient's disease in a single 0–10 score.

Objectives In this study, we aimed to identify the PASDAS cut-off points for PASS, and to examine the agreement between PASS and the PASDAS thresholds for low (<3.2), moderate (3.2–5.4), and high disease activity (>5.4).

Methods Patients were prospectively recruited from the University of Toronto PsA clinic. A standard protocol including physician assessment and patient-reported outcomes was used to record variables required to calculate PASDAS. In addition, each patient was asked to “think about all the ways your PsA has affected you during the last 48 hours. If you were to remain in the next few months as you were during the last 48 hours, would this be acceptable to you?” to assess PASS. For analysis, the PASDAS threshold for PASS was identified with the ROC analysis to maximize specificity and sensitivity. Furthermore, the agreement between PASS and low, moderate, and high PASDAS disease activity cut-offs were evaluated.

Results 169 patients [61% male, mean age 56.1, mean disease duration 16.9 years, mean (SD) PASDAS 3.25 (1.1)] were recruited. The PASDAS threshold for the patient acceptable symptoms state (PASS+) was identified to be 3.84 (AUC – 0.88, sensitivity 0.82, specificity 0.94) using ROC curve analysis. 91% of patients with low disease activity (PASDAS <3.2) considered their symptoms state acceptable (PASS+), and 100% of the patients with high disease activity (PASDAS >5.4) considered their symptom state as unacceptable (PASS-). Furthermore, the mean (SD) PASDAS was 4.5 (1.0) in the PASS- group and 2.8 (1.1) in the PASS+ group.

Conclusions The PASDAS threshold for patient acceptable symptoms state is 3.84, which is within the moderate disease activity range. Thus with a PASDAS of 3.84 or lower, PsA patients consider their symptom state acceptable for the next few months. This cut-off should be considered for shared decision making regarding treatments in PsA patients.

Disclosure of Interest None declared

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.