Long-term outcomes of patients who rate symptoms of rheumatoid arthritis as “satisfactory”

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Objectives: To describe outcomes of patients with early rheumatoid arthritis (RA) in a patient acceptable symptom state (PASS) at treatment initiation and to identify clusters of symptoms associated with poor outcomes.

Methods: Data came from the Rheumatoid Arthritis Medication Study (RAMS), a UK multi-centre cohort study of RA patients starting methotrexate. The Health Assessment Questionnaire (HAQ), Disease Activity Score 28 (DAS28) and other patient reported outcome measures (PROMs) were collected at baseline, six and twelve months. Patients answering yes to the question “Is your current condition satisfactory, when you take your general functioning and your current pain into consideration?” were defined as PASS; patients answering no were defined as N-PASS. Symptom clusters in the baseline PASS group were identified using K-medians cluster analysis. Outcomes of baseline PASS vs. N-PASS patients and each cluster are compared using random effects models.

Results: Of 1127 patients, 572 (50.8%) reported being in PASS at baseline. Over one year, baseline PASS patients had lower DAS28 (mean difference = -0.71, 95% CI -0.83, -0.59) and HAQ scores (mean difference = -0.48, 95% CI -0.56, -0.41) compared to N-PASS patients. Within the baseline PASS group, we identified six symptom clusters. Clusters characterised by high disease activity and high PROMS, or moderate disease activity and high PROMs, had the worst outcomes compared to the other clusters.

Conclusions: Despite reporting their condition “satisfactory”, early RA patients with high PROM scores are less likely to respond to therapy. This group may require increased vigilance to optimise outcomes.
Original languageEnglish
JournalRheumatology (Oxford)
Publication statusPublished - 15 Nov 2019


  • Rheumatoid arthiritis
  • epidemiology
  • disability
  • cluster analysis
  • patient acceptable symptom state


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