Assessment of residual symptoms using the Okomarigoto Sheet can complement evaluation of the patient acceptable symptom state in patients with rheumatoid arthritis.

Abstract

Objectives: Although clinical remission is the primary treatment goal in rheumatoid arthritis (RA), many patients continue to experience residual symptoms that impair quality of life. This study examined whether the complete absence of residual symptoms, assessed using the Okomarigoto Sheet (OS), is associated with achieving the Patient Acceptable Symptom State (PASS), including among patients in Simplified Disease Activity Index (SDAI)-defined remission.

Methods: This cross-sectional, single-center study included 260 consecutive patients with RA. Residual symptoms were evaluated using the OS, with particular emphasis on whether an OS score of zero was associated with PASS achievement. Clinical characteristics were compared between groups, and factors associated with PASS non-achievement were analysed using univariate and multivariate logistic regression analyses.

Results: Of the 260 patients, 196 achieved PASS. An OS score of zero was strongly associated with PASS achievement (odds ratio [OR], 11.02; 95% confidence interval [CI], 4.06-29.2; P < .001). Among patients in SDAI remission, none of the PASS nonachievers had an OS score of zero. PASS nonachievement was associated with higher disease activity, greater functional impairment, and persistent residual symptoms. Multivariate analysis identified Steinbrocker class, C-reactive protein, and total OS score (OR, 1.27; 95% CI, 1.13-1.43; P < .001) as independent predictors of PASS nonachievement. In patients in SDAI remission, OS-assessed pain independently predicted PASS nonachievement.

Conclusions: The complete absence of residual symptoms, as measured by the OS, was strongly associated with achieving PASS, even among patients in SDAI-defined remission. Systematic evaluation and targeted management of residual symptoms may improve patient satisfaction and facilitate shared decision-making in RA care.