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    woman holding her wristWhat Is Arthritis?

    Arthritis is not one disease. Learn about the different types of arthritis, how they differ and why it’s important.

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    Woman with upset stomachMicrobiome, Gut Health & Arthritis

    Microbiome, microbes, microorganisms – these terms may be confusing, but the types of bacteria living in and on our bodies can impact arthritis. Learn what helps or harms the microbiome and the health of your gut and discover dietary changes that can make a difference. This episode was originally released on January 19, 2021.

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    Learn about the connection between arthritis, depression and anxiety and how these conditions can make your arthritis worse.

    Woman ExercisingYour Exercise Solution (YES)

    Movement is the best medicine, even when your joints hurt. Your Exercise Solution (YES) is a resource to help you create a physical activity routine with modifications developed and approved by physical therapists.

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Your RA is in Remission! Now What? 

With aggressive treatment, RA can go into remission (no visible signs or symptoms. Learn if it’s possible to take less medication or even a drug holiday.  

By Beth Axtell 

There is no cure for rheumatoid arthritis (RA), but remission can feel like it. Today, early and aggressive treatment with disease-modifying antirheumatic drugs (DMARDs) and biologics makes remission more achievable than ever before. But how likely are you to reach remission, and how likely are you to sustain it? And when you reach it, do you stay on your medications or go off them? 

When remission in RA was first defined 1981, it was characterized as elimination of all disease. “That’s a very hard target. We’re more likely to be able to reach limited or small amount of disease,” explains David T. Felson, MD, professor of medicine at Boston University and a practicing rheumatologist. 

With that in mind, the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) developed criteria for defining remission so researchers could compare the effectiveness of different treatment regimens.  

Definitions of Remission in Rheumatoid Arthritis 

These criteria are used by scientists when conducting clinical trials. Your rheumatologist may use these or slightly different measures to determine if your disease is in remission: 

  • One or fewer swollen joints 

  • One or fewer tender joints 

  • An assessment by the patient that on a 0–10 scale, arthritis activity is 1 or less 

  • A blood test showing little or no inflammation in levels of C-reactive protein, a key marker of inflammation 

A second definition uses the Simplified Disease Activity Index to measure disease activity. It consists of a sum score of the four measures in the first definition plus a physician assessment. 

The Odds of Remission 

Because the definition of RA remission has been subjective in the past, published rates vary greatly, ranging from as little as 10% to more than 60%. The most important factor is early diagnosis and aggressive treatment. 

“When treated early with DMARDs and biologics, remission rates can exceed 60%,” says Paul Emery, MD, director, Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, United Kingdom, and one of the authors of the ACR/EULAR definition. For people who don’t begin treatment within two years of first symptoms or who don’t start biologics early in the course of disease, remission rates will range from 10% to 33%, as reported in various studies. 

Having low disease activity levels at the start of treatment is also a predictor of being able to attain and maintain remission. 

Being negative for the disease markers anti-cyclic citrullinated peptide (anti-CCP) antibody, rheumatoid factor and the shared epitope have been associated with a higher chance of realizing remission.  

Drug-free Remission 

Once remission has been achieved, whether you stop taking your RA medication is up to you and your doctor. Vivian Bykerk, MD, director of the Inflammatory Arthritis Center of Excellence, Hospital for Special Surgery, New York City, makes sure her patients maintain remission-level symptoms for at least one year before reducing their medications. 

“Generally, I will slowly taper drugs one at a time: first steroids [earlier than one year], then biologics and finally methotrexate,” she says. 

Dr. Emery keeps patients in a medicated remission for six months and then slowly reduces the medication dosages. “Remission is attainable for a good number of people – if you get diagnosed early and treated aggressively – but sustaining a drug-free remission for more than a year or so is unlikely,” he says.  

 

While complete treatment withdrawal may be effective for a small number of patients, maintaining remission with a reduced-dose regimen, as Dr. Emery indicated, is likely the best option for many people. That’s because the disease may still be active even though signs of it appear to be gone. Inflammation and joint damage may continue even in the absence of pain and apparent swelling. In such cases, magnetic resonance images may reveal underlying inflammation. The results of several studies strengthen the case for reducing medication dosage rather than stopping completely.  

 

Should You Take a Drug Holiday? 

Many doctors favor reducing dosages in hopes of maintaining remission but taking a drug holiday could be an option. 

If you and your doctor decide you are a candidate for a drug holiday – a temporary stoppage of treatment – consider a few factors: the potential effect on your medication eligibility with your insurance company, the effectiveness of the drug when you restart it, and whether underlying joint damage continues even when RA is in remission. 

“Patients may have to change to another biologic by their insurer if, for example, the formulary has changed,” says Dr. Bykerk. “Also, if the same biologic is reintroduced, there is a chance that the patient may have developed anti-drug antibodies to the biologic, resulting in a worse response when using it the second time around.” 

If you achieve remission, you and your doctor can weigh the benefits and risks of taking a drug-free holiday. During this time, it’s important that your doctor monitors you closely for signs of worsening disease activity or joint damage.  

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Help millions of people live with less pain and fund groundbreaking research to discover a cure for this devastating disease. Please, make your urgently-needed donation to the Arthritis Foundation now!

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The Arthritis Foundation is focused on finding a cure and championing the fight against arthritis with life-changing information, advocacy, science and community. We can only achieve these goals with your help. Strong, outspoken and engaged volunteers will help us conquer arthritis. By getting involved, you become a leader in our organization and help make a difference in the lives of millions. Join us and become a Champion of Yes.

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Give Just 10 Minutes.

Tell us what matters most to you. Change the future of arthritis.

By taking part in the Live Yes! INSIGHTS assessment, you’ll be among those changing lives today and changing the future of arthritis, for yourself and for 54 million others. And all it takes is just 10 minutes.

Your shared experiences will help:

- Lead to more effective treatments and outcomes
- Develop programs to meet the needs of you and your community
- Shape a powerful agenda that fights for you

Now is the time to make your voice count, for yourself and the entire arthritis community. 

Currently this program is for the adult arthritis community.  Since the needs of the juvenile arthritis (JA) community are unique, we are currently working with experts to develop a customized experience for JA families. 

How are you changing the future?

By sharing your experience, you’re showing decision-makers the realities of living with arthritis, paving the way for change. You’re helping break down barriers to care, inform research and create resources that make a difference in people’s lives, including your own.

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Meet Our Partners

As a partner, you will help the Arthritis Foundation provide life-changing resources, science, advocacy and community connections for people with arthritis, the nations leading cause of disability. Join us today and help lead the way as a Champion of Yes.

Trailblazer

Our Trailblazers are committed partners ready to lead the way, take action and fight for everyday victories. They contribute $2,000,000 to $2,749,000

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Our Visionary partners help us plan for a future that includes a cure for arthritis. These inspired and inventive champions have contributed $1,500,00 to $1,999,999.

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Our Pioneers are always ready to explore and find new weapons in the fight against arthritis. They contribute $1,000,000 to $1,499,999.

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Our Pacesetters ensure that we can chart the course for a cure for those who live with arthritis. They contribute $500,000 to $999,000.

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Our Signature partners make their mark by helping us identify new and meaningful resources for people with arthritis. They contribute $250,000 to $499,999.

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Our Supporting partners are active champions who provide encouragement and assistance to the arthritis community. They contribute $100,000 to $249,999.

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