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.