PESS Outcome Measure Offers Reliable Insight Into RA Remission Status

The Patient Experienced Symptom State (PESS) global outcome measure may be a simple tool to identify disease remission status in patients with rheumatoid arthritis.

Patients with rheumatoid arthritis (RA) who say their disease is in a very good state according to the Patient Experienced Symptom State (PESS) global outcome measure tend to have good or full control of disease, suggesting that this simple tool could be useful in identifying disease remission status in this patient population, according to study results published in Rheumatology.

The PESS assesses RA with the question, “Consider how your rheumatic disease has affected you during the last week. If you remain in the coming months as you have been the last week, how would you rate your condition?” The responses are reported in 5 Likert scale levels, which range from “very bad” to “very good.”

In this study, the researchers performed a cross-sectional analysis of the RA Impact of Disease study and the Norwegian DMARD registry. Data from 1407 patients with RA and a mean disease duration of 14.3 years were obtained from these datasets and were included in the analysis. Validated disease activity scores, including the Disease Activity Score-28 based on erythrocyte sedimentation rate (DAS28-ESR), Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI), as well as measures such as the RA Impact of Disease (RAID) and modified Health Assessment Questionnaire were assessed against the construct validity of PESS.

Approximately 16.3% of patients with RA considered they were in a very good state according to the PESS measure. In contrast, approximately 21.6% of patients considered they were in a good state and 31.9% of patients considered themselves in an acceptable state. There were significant differences between all 5 levels of PESS in terms of patients’ age, disease duration, DAS28-ESR with 3 variables and 4 variables, SDAI, CDAI, American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria for remission, Patient Global Assessment, modified Health Assessment Questionnaire, and RAID score (P <.01 for all).

The cutoff values for the DAS28-ESR with 4 variables that corresponded to good or very good PESS states considered in the range of low disease activity/remission were ≤2.6/≤2.3. The cutoff values were ≤5.0/≤3.1 for CDAI and ≤5.1/≤3.8 for SDAI. In addition, the cutoff values that corresponded to good and very good PESS states were in the very low disease impact range for RAID domains ≤1.

A limitation of this study was the inclusion of datasets comprising only patients from academic centers in Norway, which may limit the applicability of the findings.

Based on these research results, the study investigators suggested that a “‘very good’ PESS status provides a more stringent definition of target status than [the Patient Acceptable Symptom State (PASS) measure] and can be considered a more appropriate treatment target both from the physician’s and from the patient’s perspective…[P]rogressive improvement along the PESS levels seems to offer a reliable indication of improvement of both disease activity and impact.”

Disclosure: The Norwegian DMARD study was funded by the pharmaceutical industry. Please see the original reference for a full list of disclosures.


Duarte C, Santos E, da Silva JAP, et al. The Patient Experienced Symptom State (PESS): a patient-reported global outcome measure that may better reflect disease remission status [published online May 6, 2020]. Rheumatology (Oxford). doi:10.1093/rheumatology/keaa149.