Residual symptom absence assessed by Okomarigoto Sheet is independently associated with patient-acceptable symptom state beyond inflammation in rheumatoid arthritis.

OBJECTIVES

Telemedicine has expanded rapidly, increasing reliance on patient-reported outcome measures (PROMs) for disease assessment in rheumatoid arthritis (RA). However, conventional PROMs may inadequately capture residual symptoms, resulting in discordance between inflammatory control and patient-perceived burden. The Okomarigoto Sheet (OS) was developed to evaluate residual symptoms. This study assessed the clinical relevance of the OS as a complementary tool to conventional PROMs in RA.

METHODS

This cross-sectional, single-center study included patients with RA. Residual symptoms were evaluated using OS, and patient-acceptable symptom state (PASS) was assessed using the current PASS framework. Associations between OS and Routine Assessment of Patient Index Data 3 (RAPID3) were examined, and the proportion of OS = 0 was compared across RAPID3 categories. Multivariate logistic regression was performed to identify factors associated with PASS nonachievement, including OS = 0, RAPID3, and Simplified Disease Activity Index (SDAI) remission.

RESULTS

Among 363 patients, the total OS score correlated with RAPID3 (r = 0.632, p < 0.001); however, residual symptoms persisted even in low disease activity. In multivariate analyses, an OS = 0 was independently associated with a lower likelihood of PASS nonachievement (OR = 0.23, p = 0.002), along with SDAI remission (OR = 0.10, p < 0.001). RAPID3 was not significant after adjustment. Model fit improved with OS inclusion.

CONCLUSIONS

The OS provided complementary information beyond RAPID3 and remained independently associated with PASS after adjustment for inflammation. Patient acceptability depends not only on inflammatory control but also on the resolution of residual symptoms. Incorporating the OS may enhance patient-centered evaluation, including telemedicine settings. Key Points • Residual symptom absence independently determines patient-acceptable symptom state beyond inflammatory control. • RAPID3 alone may underestimate residual symptoms relevant to patient-perceived disease burden. • Okomarigoto Sheet complements conventional measures by detecting clinically meaningful residual symptoms.