Background/Purpose:

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. Disease Activity index for Psoriatic Arthritis (DAPSA) is a score recently validated for its utilization in PsA, focusing on the evaluation of disease activity in the joints. In this study, we aimed to 1) identify the PASDAS and DAPSA cut-off points for PASS, 2) to examine the agreement between PASS and the published PASDAS thresholds for low (<3.2), moderate (3.2-5.4), and high disease activity (>5.4), and 3) to examine the agreement between PASS and the defined DAPSA thresholds for disease remission (≤4), low (>4 and ≤14), moderate (>14 and ≤28), and high (>28) disease activity.

Methods: Patients were prospectively recruited from a PsA clinic. A standard protocol including physician assessment and patient-reported outcomes was used to record variables required to calculate PASDAS and DAPSA. In addition, each patient was asked, “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 and DAPSA thresholds for PASS were identified using ROC curve analyses to maximize specificity and sensitivity. Furthermore, the agreement between PASS and low, moderate, and high PASDAS disease activity cut-offs; as well as between PASS and disease remission, low, moderate, and high DAPSA disease activity cut-offs were evaluated.

Results: 229 patients [58.5% male, mean age 55.5, mean disease duration 17.2 years] were recruited. 1) The PASDAS threshold for the patient acceptable symptoms state (PASS+) was identified to be 3.79 (AUC: 0.86, sensitivity 0.75, specificity 0.82), and the DAPSA threshold for PASS+ was 13.53 (AUC: 0.85, sensitivity 0.88, specificity 0.72) using ROC curve analyses. 2) When examining the agreement between PASS and PASDAS, 90.3% of patients with low disease activity considered their symptoms state acceptable compared to 55.0% with moderate disease activity and 16.7% with high disease activity. The mean difference in PASDAS between those reporting unacceptable versus acceptable PASS was significantly different (p<0.001), with mean (SD) PASDAS of 4.4 (1.0) and 2.7 (1.1), respectively. 3) With DAPSA, 97.0% of patients in disease remission considered their symptoms state acceptable compared to 89.4% with low, 45.4% with moderate, and 35.7% with high disease activity. The mean difference in DAPSA between those reporting unacceptable vs acceptable PASS was also significantly different (p<0.001), with mean (SD) DAPSA of 25.3 (16.3) and 11.6 (13.2) respectively.

Conclusion:

The PASDAS threshold for patient acceptable symptoms state is 3.79, which is within the moderate disease activity range. Meanwhile, the DAPSA threshold for patient acceptable symptoms state is 13.53, in the low disease activity range. Theses cut-offs should be considered for shared decision making regarding initiating, changing, and/or escalating treatments in PsA patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-relationship-between-the-patient-acceptable-symptom-state-pass-and-disease-activity-in-patients-with-psoriatic-arthritis-psa/