Rheumatoid arthritis is generally considered a chronic, lifelong condition. However, new treatments sometimes lead to dramatic improvements in the signs and symptoms of the condition. They can even prevent joint damage and lead to remission.
Doctors and people living with RA may both have remission as a goal. But they might not agree on exactly what remission means and what it looks like. You may think of remission as freedom from symptoms, while your doctor will follow a more technical medical definition.
Read on to get the facts about RA remission and the treatment approaches that make remission more likely.
Remission is hard to define
The American College of Rheumatology (ACR) has complex guidelines for defining RA remission. The guidelines look at many different numerical markers that measure how RA works in the body. This includes disease activity hidden from the person diagnosed with RA.
In essence, you could feel like your RA is in remission, but your doctor could evaluate the numbers, as well as X-rays and others imaging studies, and determine that you aren’t technically in remission.
A 2014 survey of people with RA shows this difference in perception. Only 13 percent understood remission as meeting a medical definition that measured disease activity. Instead, 50 percent said remission was the point of being “symptom free,” and 48 percent describe remission as “pain free.”
Understanding that the medical definition of remission can differ from your personal perception may help you stay on track with your treatment plan. Even if you’re feeling better, symptom improvement alone doesn’t mean you’re in remission. You shouldn’t stop taking your medication without talking to your doctor.
Many people experience RA remission
Because remission is hard to define, it’s also hard to know how many people actually experience remission. Even when remission is defined by the clinical criteria, studies use different timelines to measure rates. That makes it even harder to know how often it happens and for how long.
A 2017 review of RA remission studies found that remission rates ranged from 5 percent to 45 percent, based on standard criteria. However, there was no standard period of time to define remission. To better understand future data, the review recommended setting standards for how long the low disease activity must last to qualify as remission.
These numbers may not seem encouraging. But it may help to remember that people often define remission differently than doctors. Some people may experience long periods of time living symptom free, even though they’re not technically considered to be in remission. Experiencing this improvement in quality of life and freedom from pain can be more important, for some, than meeting a technical definition.
Early intervention is a factor in remission rates
The 2017 review notes that an early intensive treatment approach is associated with higher rates of lasting remission. Researchers may discuss remission in terms of “early” versus “established” RA. One goal of early interventions is to start treatment before joint erosion, according to the Arthritis Foundation.
Even for those who have lived with RA for years, remission can sometimes occur. Early and aggressive therapy, however, may lead to better outcomes. Regardless of disease stage, it’s important to stay engaged with your doctor about your treatment plan.
Lifestyle may play a role in remission rates
Medications are a vital component of RA treatment, but lifestyle may also play a role in the likelihood of remission. A 2018 study found that about 45 percent of people who get early RA intervention don’t achieve remission within one year.
The study looked at what factors are the biggest predictors that individuals won’t go into remission. For women, obesity was the strongest predictor that study participants wouldn’t go into remission within one year of starting treatment. For men, smoking was the strongest predictor.
The researchers noted that prioritizing weight management and stopping smoking might lead to rapid reduction in inflammation. This is one of the main goals of RA treatment. In general, the study suggests that overall health may contribute to how effectively a treatment works.
Relapse can follow remission
People living with RA can go back and forth between remission and relapse. The reasons are unclear.
During periods of remission, most people with RA continue taking medication to maintain remission. This is because tapering off medication could lead to a relapse.
The ultimate goal is to have a drug-free, sustained remission. Research is ongoing to find new treatment strategies to accomplish this goal.
In some cases, medications may stop working. This may happen with biologics as well. The body can create antibodies that reduce the effectiveness of medications. Even if a therapy appears to be working successfully, relapse is still possible.
Doctors and people living with RA may define remission in different ways. However, they share the goal of reducing RA symptoms and progression. Early treatment leads to a greater likelihood of sustained remission. Sticking with your treatment plan is important to give yourself the best chance at remission.