Puyraimond-Zemmour Déborah, Etcheto Adrien, Fautrel Bruno, Balanescu Andra, de Wit Maarten, Heiberg Turid, Otsa Kati, Kvien Tore K, Dougados Maxime, Gossec Laure
Sorbonne University, UPMC University Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Paris, France.
Paris Descartes University, Cochin Hospital, AP-HP, INSERM, PRES Sorbonne Paris-Cité, Paris, France.
Arthritis Care Res (Hoboken). 2017 Oct;69(10):1504-1509. doi: 10.1002/acr.23176. Epub 2017 Sep 6.
To explore the link between a patient acceptable symptom state (PASS) and patient-perceived impact in rheumatoid arthritis (RA) and psoriatic arthritis (PsA).
This was a cross-sectional study of unselected patients with definite RA or PsA. Pain, functional capacity, fatigue, coping, and sleep disturbance were assessed using a numeric rating scale (0-10) and compared between patients in PASS or not (Cohen's effect sizes). The domains of health associated with PASS status were assessed by multivariate forward logistic regression, and PASS thresholds were determined using the 75th percentile method and receiver operating characteristic analyses.
Among 977 patients (531 with RA, 446 with PsA), the mean ± SD age was 53.4 ± 13.2 years, mean ± SD disease duration was 11.2 ± 10.0 years, and 637 (65.8%) were women. In all, 595 patients (60.9%) were in PASS; they had lower symptom levels, and all domains of health except sleep disturbance discriminated clearly between patients in PASS or not (effect sizes 0.73-1.45 in RA and 0.82-1.52 in PsA). In multivariate analysis, less pain and better coping were predictive of being in PASS. Odds ratios were: RA pain 0.80 (95% confidence interval [95% CI] 0.67-0.96), PsA pain 0.63 (95% CI 0.52-0.75), RA coping 0.84 (95% CI 0.74-0.96), and PsA coping 0.83 (95% CI 0.71-0.97). The cutoffs of symptom intensity (range 0-10), corresponding to PASS for the 5 domains of health and the 2 diseases were similar, i.e., approximately 4-5.
In RA and PsA, PASS was associated with the 5 domains of health analyzed, and in particular with less pain and better coping.
探讨类风湿关节炎（RA）和银屑病关节炎（PsA）患者可接受症状状态（PASS）与患者自我感知影响之间的联系。
这是一项对未经选择的确诊RA或PsA患者的横断面研究。使用数字评分量表（0 - 10）评估疼痛、功能能力、疲劳、应对方式和睡眠障碍，并在处于PASS状态和未处于PASS状态的患者之间进行比较（Cohen效应量）。通过多变量向前逻辑回归评估与PASS状态相关的健康领域，并使用第75百分位数法和受试者工作特征分析确定PASS阈值。
在977例患者中（531例RA患者，446例PsA患者），平均年龄±标准差为53.4±13.2岁，平均病程±标准差为11.2±10.0年，637例（65.8%）为女性。共有595例患者（60.9%）处于PASS状态；他们的症状水平较低，除睡眠障碍外，所有健康领域在处于PASS状态和未处于PASS状态的患者之间都有明显差异（RA的效应量为0.73 - 1.45，PsA的效应量为0.82 - 1.52）。在多变量分析中，疼痛较轻和应对方式较好是处于PASS状态的预测因素。比值比分别为：RA疼痛0.80（95%置信区间[95%CI]0.67 - 0.96），PsA疼痛0.63（95%CI 0.52 - 0.75），RA应对方式0.84（95%CI 0.74 - 0.96），PsA应对方式0.83（95%CI 0.71 - 0.97）。对于健康的5个领域和2种疾病，与PASS对应的症状强度（范围0 - 10）的临界值相似，即约为4 - 5。
在RA和PsA中，PASS与所分析的5个健康领域相关，尤其与疼痛较轻和应对方式较好有关。
