Can Rheumatoid Arthritis Go Into Remission?

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People with rheumatoid arthritis (RA) have symptoms, including joint pain and fatigue, that come and go. When a person with rheumatoid arthritis feels better and symptoms are under control, it is called clinical remission, or simply, RA remission. Periods of remission can make a person feel like their RA is gone—at least for a short time.

Defining Remission

Remission means that your disease is no longer active. Spontaneous remission in RA is rare. People who experience remission with RA usually do so while on medication. That means if medication is stopped, the disease will likely become active again.

RA remission may mean a person’s symptoms are completely gone, or that they have an occasional flare-up of joint pain and morning stiffness. The American College of Rheumatology has published specific guidelines for defining RA remission. Doctors will utilize these guidelines to determine if a person’s RA is in remission. While the guidelines may appear confusing at first, your rheumatologist considers RA in remission if these conditions apply to you.

Requirements for RA Remission

  • Less than 15 minutes of stiffness upon awakening in the morning
  • Little or no joint pain, tenderness, or swelling
  • Blood tests showing low levels of inflammation

Remission means that your symptoms have resolved and disease activity has stopped. Little or no disease activity translates into no continuing or lasting joint damage.

Research

The rates of remission now are higher than they used to be, especially with the use of disease modifying anti-rheumatic drugs (DMARDs) and biologics. Research from the University of Los Andes in Santiago, Chile reports rates of remission in RA may be up to 48 percent. Specific factors improve the chances of remission, including mild disease activity and short disease duration.

While remission is possible for many, the likelihood of sustained remission is rare. Recent research from Sweden finds most people with RA never reach sustained remission. They define sustained remission as remission lasting six months or more.

Sustained remission has also been found to be more common in early RA and that certain factors including disease duration and severity, gender (remission is more common in men) and age, play a part.

The research on drug-free remission is rare and often falls short. At least one report shows that chances of medication-free remission are around 3.6 to 22 percent, but further research needs to be done to determine why some people achieve drug-free remission while others do not. In particular, more research must be done to indicate what factors contribute to RA remission, including disease duration and genetics.

What researchers do know for sure is that medication-free remission is rare and often short-lived.

A review of several studies reported in the journal, Current Rheumatology Reports, finds that less than 15 percent of people with RA are able to sustain drug-free remission.

Achieving Remission

Doctors take a “treat to target” approach for managing RA, which involves a target goal, treatment options to achieve the goal, and ways to measure if the goal has been reached.

The treat to target method tends to result in higher rates of remission, less joint damage, and more sustained mobility.   

Newer research reported in Arthritis & Rheumatology finds the treat to target method to not only increase the chances of remission and lower disease activity, but it also improves cardiovascular risk factors which are higher for people with RA. Even if a person is still experiencing high disease activity, doctors know how to customize treatment plans based on a person’s symptoms and lifestyle to reduce symptoms and disease activity.

Treatment, in the form of early and aggressive therapies, is key to improving symptoms and stopping RA’s progression. This is important because it is not only your joints that are affected. RA is a systemic disease and left untreated (or under-treated), you are at further risk for a number of conditions that may harm your heart, lungs, eyes and other organs.

Even if your RA is well-treated, your risk for cardiovascular disease (CV) is much higher than it is if you do not have RA. However, effective and successful RA treatment reduces the risk. When inflammation is managed, a person will need less medication. This is crucial due to the fact that many of the drugs for treating RA increase CV risk.

RA medications are known for suppressing the body’s overactive immune system. DMARDs, such as methotrexate, are often first-line therapies for improving pain and symptoms, managing inflammation, and slowing down RA’s progression.  When these drugs do not help or are not enough, biologics are the next drug therapies doctors consider. Biologics work by blocking cytokines (inflammation-causing chemicals in the body). Most are designed to treat unique symptoms and biomarkers, which makes them stronger than DMARDs.

DMARDs and biologics are often used in combination to increase the chances of remission.

A Word From Verywell

Once a person achieves remission, it is important to do everything they can to stay there for as long as possible. The most important way is to continue taking your medications. While some researchers believe drug-remission is possible, for most people, RA requirements lifetime treatment. Even if you do not feel pain, the disease may still be affecting your joints and organs. RA drugs keep the immune system from overreacting and not taking them will cause disease symptoms to return. Additionally, stopping and starting medications may cause your immune system to no longer respond positively to medications.

In addition to staying on your medications, you should be seeing a rheumatologist regularly and practicing a healthy lifestyle to prevent flares and relieve symptoms. This includes getting enough sleep, eating a healthy and balanced diet, being active, managing stress and not smoking. Of course, lifestyle factors do not replace medications, but they should be practiced along with drug therapies.

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