Disease activity and patient‐perceived health: associations with the Patient Acceptable Symptom State (PASS) in a large multicenter systemic lupus erythematosus cohort

OBJECTIVE: We aimed to evaluate the relationship between disease activity and the Patient Acceptable Symptom State (PASS) and to identify clinical and socio-demographic factors associated with PASS in systemic lupus erythematosus (SLE). METHODS: We analyzed data from the Spanish multicenter SLE registry (RELESSER). PASS was self-reported. Disease activity was assessed using SLEDAI-2K and targeted disease activity states (DORIS remission and LLDAS). Collected variables included socio-demographic factors (age, sex, employment, educational attainment), fibromyalgia, organ damage (SDI), current therapies and the Lupus Impact Tracker (LIT). Associations with PASS were analyzed for each disease activity state measure by univariable and multivariable logistic regression. A subgroup analysis was performed in patients in DORIS remission. RESULTS: 72% of patients (n=1249) reported being in PASS. Lower SLEDAI-2K, DORIS remission and LLDAS were independently associated with being in PASS. Higher education level and being employed were positively associated, while female sex and fibromyalgia were negatively associated with PASS. After including LIT items in the models, DORIS remission and LLDAS remained associated, while pain, fatigue-related limitations and anxiety showed the strongest associations. Among patients in DORIS remission, 20% were not in PASS, with female sex, fibromyalgia, pain, fatigue-related limitations and anxiety remaining independent barriers. CONCLUSION: DORIS remission and LLDAS are associated with PASS, supporting their relevance as treatment targets from the patient's perspective. Pain, fatigue and anxiety hinder many patients with SLE from achieving satisfactory health beyond disease remission. One in five patients in remission is still not in PASS. PASS assessment may help capture unmet needs in SLE management.

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Journal
Arthritis Care & Research
Published
2026-11-04
DOI
https://doi.org/10.1002/acr.80199
Primary Topic
Systemic Lupus Erythematosus Research
Type
article
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article

Disease activity and patient‐perceived health: associations with the Patient Acceptable Symptom State (PASS) in a large multicenter systemic lupus erythematosus cohort

Esther Rodríguez-Almaraz, Irene Carrión-Barberà, Javier Narváez, Clara Sanguesa et al.
Arthritis Care & Research
Systemic Lupus Erythematosus Research
article

Disease activity and patient‐perceived health: associations with the Patient Acceptable Symptom State (PASS) in a large multicenter systemic lupus erythematosus cohort

Esther Rodríguez-Almaraz, Irene Carrión-Barberà, Javier Narváez, Clara Sanguesa, Íñigo Rúa‐Figueroa, Sílvia Gómez, Sandra Garrote, Julia Martínez‐Barrio, Esther Ruiz-Lucea, César Magro‐Checa, Silvia Garcia-Cirera, José María Pego‐Reigosa, Inmaculada Ros‐Vilamajó, Eva Tomero, Jaime Calvo‐Alén, María Galindo-Izquierdo, Zulema Plaza, Natalia Mena‐Vázquez, Ricardo Blanco, Raul Menor-Almagro, Clara Moriano-Morales, José Rosas, Mercedes Freire, Eva Salgado, Josef S Smolen, Hanna Kenjic, Carlota Iñiguez
article en

Abstract

OBJECTIVE: We aimed to evaluate the relationship between disease activity and the Patient Acceptable Symptom State (PASS) and to identify clinical and socio-demographic factors associated with PASS in systemic lupus erythematosus (SLE). METHODS: We analyzed data from the Spanish multicenter SLE registry (RELESSER). PASS was self-reported. Disease activity was assessed using SLEDAI-2K and targeted disease activity states (DORIS remission and LLDAS). Collected variables included socio-demographic factors (age, sex, employment, educational attainment), fibromyalgia, organ damage (SDI), current therapies and the Lupus Impact Tracker (LIT). Associations with PASS were analyzed for each disease activity state measure by univariable and multivariable logistic regression. A subgroup analysis was performed in patients in DORIS remission. RESULTS: 72% of patients (n=1249) reported being in PASS. Lower SLEDAI-2K, DORIS remission and LLDAS were independently associated with being in PASS. Higher education level and being employed were positively associated, while female sex and fibromyalgia were negatively associated with PASS. After including LIT items in the models, DORIS remission and LLDAS remained associated, while pain, fatigue-related limitations and anxiety showed the strongest associations. Among patients in DORIS remission, 20% were not in PASS, with female sex, fibromyalgia, pain, fatigue-related limitations and anxiety remaining independent barriers. CONCLUSION: DORIS remission and LLDAS are associated with PASS, supporting their relevance as treatment targets from the patient's perspective. Pain, fatigue and anxiety hinder many patients with SLE from achieving satisfactory health beyond disease remission. One in five patients in remission is still not in PASS. PASS assessment may help capture unmet needs in SLE management.

Arthritis Care & Research
Universidade da Coruña (ES), Universidade de Santiago de Compostela (ES), Leiden University Medical Center (NL), Bellvitge University Hospital (ES), Hospital General Universitario Gregorio Marañón (ES), Research Institute Hospital 12 de Octubre (ES), Institut d'Investigació Biomédica de Bellvitge (ES), Hospital Son Llatzer (ES), Hospital de Basurto (ES), Complejo Hospitalario Universitario de Santiago (ES), Hospital Universitario de Gran Canaria Doctor Negrín (ES), Marqués de Valdecilla University Hospital (ES), Hospital Universitario Rey Juan Carlos (ES), Sociedad Española de Reumatología (ES), Hospital Universitario 12 De Octubre (ES), Hospital Regional Universitario de Málaga (ES), Hospital Universitario Araba (ES), Corporació Sanitària Parc Taulí (ES), Instituto Bernabeu (ES), Hospital Universitario de La Princesa (ES), Hospital Del Mar (ES), Zuyderland Medisch Centrum (NL), Hospital General Universitario de Alicante Doctor Balmis (ES), Hospital Universitario Lucus Augusti (ES), Hospital Universitari Germans Trias i Pujol (ES), Hospital Jerez Puerta del Sur (ES), Hospital Marina Baixa (ES), Hospital Universitario Ramón y Cajal (ES), Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa (ES), Complejo Asistencial Universitario de León (ES), Universitat de Barcelona (ES)
Openalex Percentile: Top 12%
Systemic Lupus Erythematosus Research
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