Although rheumatoid arthritis (RA) is a chronic autoimmune disease, it’s possible for people living with the condition to achieve remission. Current antirheumatic treatment options can lead to dramatic improvements in RA symptoms such as inflammation and joint damage.
As remission is the goal of many treatment plans, it is important to understand what remission means and how people living with RA can reach it.
Historically, remission was defined as the complete elimination of a disease. However, current definitions focus on dramatic improvements in disease signs and symptoms.
The American College of Rheumatology and the European League Against Rheumatism specify remission criteria used by RA researchers to perform clinical trials of drugs. Rheumatologists may also use these criteria to evaluate people with RA.
According to these groups, RA remission is defined as:
Another definition of RA remission relies on a score called the Simplified Disease Activity Index (SDIA). The SDIA involves combining the scores listed above (tender joint, swollen joint, personal assessment, and CRP scores) with an additional physician assessment (called a provider global score).
The DAS28 score is a similar measure of disease activity in RA that is also used to define remission or low disease activity. DAS stands for “disease activity score,” while the number 28 refers to 28 evaluated joints. This scoring method combines several measurements, including:
Clinically, a DAS28 score of less than 3.2 indicates low disease activity, and less than 2.6 indicates remission.
Your doctor may also use X-rays, ultrasound, and MRI to help them evaluate your disease activity and remission status.
Due to various definitions of rheumatoid remission, Arthritis Foundation reports a wide range of remission rates. The likelihood of someone with rheumatoid arthritis achieving remission depends on:
Early diagnosis and aggressive RA treatment with a combination of medications may result in remission rates of 60 percent or higher. One study showed that 40 percent of people with early rheumatoid arthritis who received combination therapy with prednisone and methotrexate achieved remission. Large studies have looked at people with RA who have used conventional disease-modifying antirheumatic drugs (DMARDs), then tapered off of them. The research has found a lower sustained remission rate in these instances, occurring in 10 percent to 15 percent of people.
Several other predictors are associated with a higher chance of remission, including having low disease activity levels at the start of treatment and having seronegative RA — when your blood tests negative for specific disease markers, such as anti-cyclic citrullinated peptide antibody and rheumatoid factor.
For cases where remission isn’t possible, current therapies can effectively ease a person’s symptoms and improve quality of life.
Once an individual with RA reaches remission, they should discuss a maintenance treatment plan with their rheumatologist. The rheumatologist may recommend several different treatment plans, including:
Many people with RA hope to reduce or stop treatment once remission is reached to limit potential side effects. However, completely stopping medications comes with several risk factors, including:
It’s important to know that even though RA signs and symptoms, such as joint pain and morning stiffness, may disappear during remission, silent inflammation and joint damage can continue. One study found that continued joint damage was still observed on radiographic imaging in half of the people who reported no symptoms. Continuing on a lower dose of medication may limit continuing joint damage.
Even after remission, close monitoring by a rheumatologist and regular adjustments to treatment strategies are often needed to keep rheumatoid arthritis under control.
Early RA diagnosis and aggressive treatment with DMARDs have been found to increase the possibility of remission. DMARDs function as immune-system modulators, reducing inflammation, blocking joint damage, and easing RA symptoms.
Conventional DMARDs are oral medications that inhibit the immune system and decrease inflammation.
Biologic DMARDs and targeted synthetic DMARDs involve using inhibitors of specific immune-system molecules. These medications are effective in a significant proportion of people with RA, but they do come with a risk for side effects.
Combination therapy — using a conventional DMARD with either a targeted synthetic DMARD or a biologic DMARD — is more likely to lead to remission than monotherapy — using one medication. In addition to DMARDs, treatments available for combination therapy also include nonsteroidal anti-inflammatory drugs (or NSAIDs) and corticosteroids.
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