Evaluation of the Patient Acceptable Symptom State (PASS) in Italian Patients Affected by Systemic Lupus Erythematosus: Association with Disease Activity Indices

Abstract

ObjectivesThe aim of this study was to evaluate the discriminant capability of the patient acceptable symptom state (PASS) according to disease activity, in a cohort of Italian patients affected by systemic Lupus erythematosus (SLE).MethodsConsecutive SLE patients were enrolled. At each visit, the patients underwent a complete physical examination and the clinical/laboratory data were collected in a standardized, computerized, and electronically-filled form. The evaluation of serum complement C3 and C4 levels and determination of autoantibodies was obtained. Disease activity was assessed with the SLEDAI-2K and ECLAM, while chronic damage was measured with the SLICC. Finally, PASS was assessed in all patients by asking to answer yes or no to a single question.ResultsOne hundred sixty-five patients were enrolled (M/F 12/153; mean age 40.4±11.8 years, mean disease duration 109.1±96.2 months). No patients refused to answer, suggesting the acceptability of PASS. A total of 80% of patients rated their state as acceptable. The patients with an acceptable status had significantly lower mean SLEDAI-2K and ECLAM scores than the others [1.8±2.7 versus 3.4±2.3(P=0.004); 0.7±0.9 versus 1.4±1.1(P=0.0027)]. No significant differences were observed when considering chronic damage, evaluated with SLICC.ConclusionsIn the clinical practice, SLE patients assessment performed by using complex disease activity indices such as SLEDAI-2K and ECLAM, could be time consuming. In our study, for the first time, we used PASS, a quick and easily comprehensible tool, to evaluate the patients’ status, this single question seems to be able to discriminate patients with different disease activity, especially when this is determined by musculoskeletal involvement.

Assessment of disease activity in Systemic Lupus Erythematosus: Lights and shadows

“…In keeping with other validation studies, the result of this analysis suggested the ability of LupusQoL in capturing different levels of disease activity, unlike a generic index such as SF-36 [47]. In another study, the patient acceptable symptoms state (PASS), a tool used to evaluated patients' outcome, was found associated with disease activity [48]. PASS is a singlequestion outcome tool to evaluate the level of symptoms at which patients consider themselves well.…”

“…PASS is a singlequestion outcome tool to evaluate the level of symptoms at which patients consider themselves well. This tool has been used in a large cohort of SLE patients, identifying significantly lower levels of SLEDAI-2K and ECLAM in subjects considering their condition acceptable [48]. The study suggested the ability of PASS in discriminating patients affected by SLE with different levels of disease activity [48].…”

Pain in systemic connective tissue diseases

“…The health-related quality of life (HRQoL) of SLE patients can be evaluated by administering questionnaires such as the Short-form 36 (SF-36) [56], and the Patient Acceptable Symptom State (PASS) a simple questionnaire used to assess well-being in various rheumatic diseases including SLE [57].…”

Developing new evaluation methods in systemic lupus erythematosus

“…PASS is a single-question outcome tool to evaluate the level of symptoms at which patients consider themselves well, previously used to assess patients with inflammatory arthropathies and osteoarthritis, demonstrating a significant association with disease activity [50,51]. PASS question has been administered to 165 consecutive SLE patients demonstrating an acceptable clinical state in 80% of subjects [52]. In addition, PASS seems to be able to discriminate patients with different disease activity, as shown by the significantly lower mean SLEDAI-2K and ECLAM values in patients with an acceptable status compared with the others; moreover, active musculoskeletal involvement seemed to influence the status acceptability [52].…”

“…PASS question has been administered to 165 consecutive SLE patients demonstrating an acceptable clinical state in 80% of subjects [52]. In addition, PASS seems to be able to discriminate patients with different disease activity, as shown by the significantly lower mean SLEDAI-2K and ECLAM values in patients with an acceptable status compared with the others; moreover, active musculoskeletal involvement seemed to influence the status acceptability [52].…”