Arthritis Psoriatic Arthritis What Is Psoriatic Arthritis Remission and Is It Possible? By Lana Barhum Lana Barhum Facebook LinkedIn Lana Barhum has been a freelance medical writer for over 14 years. She shares advice on living well with chronic disease. Learn about our editorial process Updated on May 29, 2022 Medically reviewed by Scott Zashin, MD Medically reviewed by Scott Zashin, MD LinkedIn Scott J. Zashin, MD, specializes in the treatment of rheumatologic and musculoskeletal conditions using both traditional and alternative therapies. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents What Is Psoriatic Arthritis? Defining PsA Remission Treatment Goals Achieving Remission Drug-Free Remission In recent years, psoriatic arthritis (PsA) remission has become an important topic for medical research. Researchers have found that earlier diagnoses, better management of symptoms, and advances in treatments are making it easier for people with PsA to live normal and pain-free lives. Read about how PsA remission is defined and what it looks like so that you manage your expectations and work towards keeping disease symptoms from coming back. eclipse_images / Getty Images What Is Psoriatic Arthritis? Psoriatic arthritis is a type of autoimmune arthritis associated with joint and skin inflammation. PsA affects joints and surrounding structures. It can cause inflammation where tendons and ligaments attach to bone (a symptom called enthesitis), inflammation of toes or fingers (a symptom called dactylitis), inflammation of the peripheral joint lining (synovitis), and inflammation of the spine (spondylitis). PsA also affects the nails, causing pitting (small indents in the nail surface). PsA is usually connected to psoriasis, a condition where skin cells build and form scales and dry, itchy patches. These symptoms help to distinguish it from other types of inflammatory arthritis, such as rheumatoid arthritis (RA), another autoimmune disease in which an overactive immune system mistakenly attacks the joints and, in severe cases, the organs. According to data from the Cleveland Clinic, PsA prevalence varies from 0.3% to 1%, and people with pre-existing psoriasis have the highest risk for developing PsA. It is often diagnosed in middle age (ages 30 to 50) but anyone of any age can develop PsA. Women and men are equally affected, and people of Northern European descent have an increased risk. Genetics also play a role, especially family history of PsA or psoriasis. Severity and course of PsA varies from person-to-person. Some people have mild symptoms while others have severe disease activity that eventually causes joint damage and/or disability. Aggressive disease is more common in people who have more joint involvement early on, extensive skin involvement, strong family history of psoriasis, or disease onset before age 20. Early diagnosis and treatment are vital for relieving pain and inflammation, preventing progressive joint involvement and damage, and increasing the possibility of disease remission. Clinical Features of Psoriatic Arthritis Defining PsA Remission Rheumatologists (healthcare providers who specialize in arthritic conditions) define PsA remission as “minimal disease activity” status. In general, there are two types of remission in PsA: drug-induced and drug-free. Drug-induced remission indicates minimal disease activity while on medication.Drug-free remission, while rare, is complete relief from joint tenderness and swelling without the help of medication. Determining remission is based on specific criteria, which involves five clinical domains: synovitis, enthesitis, dactylitis, spondylitis, and nail and/or skin involvement. Synovitis refers to inflammation of the synovial membrane, the membrane that lines most joints. This condition is painful, especially with movement. Joints swell due to synovial fluid accumulation.Enthesitis causes inflammation where tendons and ligaments tattach to bone.Dactylitis causes severe inflammation in the fingers and toes. The swelling causes the digits to resemble sausages. If swelling is severe, the fingers can become so stiff that a person can no longer form a fist.Spondylitis refers to inflammation of the spine and associated joints.Nail and/or skin involvement: According to the National Psoriasis Foundation, up to 86% of people with PsA have nail psoriasis, which includes pitting (indents in the nails), deformation in the shape of nails, nail thickening, onycholysis (separation of the nail from the nail bed), and discoloration, usually appearing like a fungal infection. More than 80% of people with PsA have both joint and skin involvement. These people tend to have overall severe disease state, worse outcomes, and increased need for medical care. Skin problems caused by PsA include psoriasis plaques that appear on skin, especially on the knees, elbows, hands, feet, low back, and scalp. Plaques may be itchy and painful and bleed. They will vary in size and join together to cover large areas of the skin. The significant reduction of these symptoms—or minimal disease activity—is considered remission from PsA. In addition to helping with making a confirmation of remission, these clinical domains are important in both diagnosis and treatment. Psoriatic Arthritis Treatment Goals In the last decade, a treat-to-target (T2T) has become the recommended approach for treating PsA. Treat-to-target in PsA means setting specific testing goals—either remission or low disease activity—and adjusting therapy to achieve them. In addition, numerous new treatment therapies have become available to people with PsA. One 2018 study reported in the journal, Arthritis Research & Therapy looked at clinical disease status of people with PsA treated in an outpatient clinic setting during the years 2008 to 2017. The Norwegian study involved the collection of data, including demographics, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) blood work to check inflammation levels, and clinical measures of disease activity based on severity, disease activity, and modified disease activity, researcher assessments, patient-reported outcomes of function, pain, and disease-modifying antirheumatic drug (DMARD) use. An earlier study from 2010, also reported in Arthritis Research & Therapy, examined remission rates in people with PsA who were treated with anti-tumor necrosis factor alpha (TNFα) therapy. TNF inhibitors suppress response to tumor necrosis factor (TNF), a protein that is part of the inflammatory process. What the researchers found was that even with the availability of highly effective medicines such as biologic treatments, there is a need to improve remission rates. Further, newer treatment options and the development of attainable and valid measures should help to improve remission odds. The study from researchers out of University College Dublin, Ireland analyzed a group of people attending a biologic clinic from November 2004 to March 2008. Patients had rheumatoid arthritis or PsA. Criteria for assessment included demographics, previous DMARD use, tender and swollen joint counts, morning stiffness, pain score, patient assessment, CRP blood work, and health assessment questionnaires. After 12 months of treating with TNF inhibitor therapy, 58% of the PsA patients achieved remission, this compared to only 44% of the RA patients. CRP levels also were checked, and researchers noted inflammation levels were much less for the people with PsA. How Psoriatic Arthritis Is Treated Achieving Remission Remission in PsA means there is an absence of signs of disease activity, which can include symptoms and inflammation blood markers. In people who have long-standing disease, low disease activity, or few disease signs, it is a reasonable goal. The standard treatment approach for PsA is T2T. The goal of T2T in PsA is remission or inactive disease. Psoriatic arthritis T2T involves medication adjustment over time to achieve a pre-determined goal, usually remission. The process is ongoing and involves repeated adjustment of therapy to come as close to the goal of remission or low disease activity. Depending on a person’s overall health and level of disease activity, monitoring can be as frequent as every month or every few months. At each visit, your healthcare provider will evaluate to see if you are meeting the targeted goal. If the goal is not met, medication dose may be increased, new drugs may be added, or medication may be switched out to a different class of drugs. One study reported in the December 2015 publication of The Lancet put the T2T approach to the test. In this trial, 206 patients with early PsA were randomized to receive standard care or tight control management for 48 weeks. The tight control group was seeing their healthcare providers once a month and had pre-determined targets and a specific treatment protocol that included DMARDs. The ultimate goal was minimal disease activity. Those in the standard care group were seen by their healthcare providers every 12 weeks and were treated as their practitioners deemed appropriate with no set protocol or treatment goal. Results showed that compared to the control group, those in the tight control group (T2T) were far more likely to achieve improvement in both joint and skin symptoms. Drug-Free Remission While only a few recent studies have addressed PsA remission, most researchers agree starting PsA treatment as early as possible increases the chance of remission and could potentially make lasting remission more likely. However, because relapse rates are quite high when PsA treatment is discontinued, drug-free remission is rarely achieved. Findings from a 2015 study reported in the Annals of the Rheumatic Diseases support this idea. The German study observed 26 PsA patients for six months who were on methotrexate or a TNF inhibitor. These patients did not have joint pain or musculoskeletal symptoms and some skin involvement. The researchers found incidence of disease relapse was high after treatment discontinuance, affecting 20 of the patients. The researchers concluded stopping treatment—even in people with remission for more than six months—was not realistic because the rate for flare-ups (periods of high disease activity) in PsA is higher when a person is not taking medications. Living With Psoriatic Arthritis A Word From Verywell These is no cure for psoriatic arthritis. If you are lucky enough to experience remission, your healthcare provider will likely want you to keep taking medications. Making lifestyle changes can also help prevent symptoms from returning. This may include joint protection, weight management, a healthy diet, and joint-friendly exercises, such as swimming, walking and biking. Starting treatment as early as possible will slow down the disease and make remission possible. Additionally, early, aggressive treatment prevents joint damage and disability and leads to a better long-term outlook. You can increase your odds of remission by working closely with your rheumatologist and taking all treatments as prescribed. PsA remission can last weeks, months, or even years. But remission will not be permanent and your symptoms may suddenly return. If this happens, talk to your healthcare provider as soon as you can. An Overview of Psoriatic Disease 9 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Husni ME. Cleveland Clinic. Psoriatic Arthritis. Mease PJ, Coates LC. Considerations for the definition of remission criteria in psoriatic arthritis. Semin Arthritis Rheum. 2018 Jun;47(6):786-796. doi:10.1016/j.semarthrit.2017.10.021 National Psoriasis Foundation. Managing nail psoriasis. de Vlam K, Merola JF, Birt JA, et al. Skin Involvement in Psoriatic Arthritis Worsens Overall Disease Activity, Patient-Reported Outcomes, and Increases Healthcare Resource Utilization: An Observational, Cross-Sectional Study. Rheumatol Ther. 2018 Dec;5(2):423-436. doi:10.1007/s40744-018-0120-8 Haugeberg G, Michelsen B, Tengesdal S, et al. Ten years of follow-up data in psoriatic arthritis: results based on standardized monitoring of patients in an ordinary outpatient clinic in southern Norway. Arthritis Res Ther. 2018 Aug 2;20(1):160. doi:10.1186/s13075-018-1659-z Saber TP, Ng CT, Renard G, et al. Remission in psoriatic arthritis: is it possible and how can it be predicted? Arthritis Res Ther. 2010;12(3):R94. doi:10.1186/ar3021 Coates LC, Lubrano E, Perrotta FM, et al. What Should Be the Primary Target of "Treat to Target" in Psoriatic Arthritis? J Rheumatol. 2019 Jan;46(1):38-42. doi:10.3899/jrheum.180267 Coates LC, Moverley AR, McParland L, et al. Effect of tight control of inflammation in early psoriatic arthritis (TICOPA): a UK multicentre, open-label, randomised controlled trial. Lancet. 2015 Dec 19;386(10012):2489-98. doi:10.1016/S0140-6736(15)00347-5 Araujo EG, Finzel S, Englbrecht M, et al. High incidence of disease recurrence after discontinuation of disease-modifying antirheumatic drug treatment in patients with psoriatic arthritis in remission. Ann Rheum Dis. 2015 Apr;74(4):655-60. doi: 10.1136/annrheumdis-2013-204229 By Lana Barhum Lana Barhum has been a freelance medical writer since 2009. She shares advice on living well with chronic disease. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit