Remission! Now What?

“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.

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

Being a man will slightly increase your chance of 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. I

2 Replies

  • I like their definition of remission

    The ACR and the EULAR developed criteria defining remission in RA in 2011. 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.

    That is almost exactly where I am at mostly because of my diet and exercise lifestyle with CRP coming in at 9 mg/L from last Monday's blood test, and expect to be exactly at next month. Then my test is to reduce the MTX and then, imo, we are at the million dollar question... Will I stay in remission. My guess is my markers will go up a little and then come down, permanently.

  • Great to know that you are in good control of your RA too. Diets do help to keep us healthy, however, it is the key to ensure we work closely with our rheumatologists on the slowly reduce in DMARDs intake. I am very careful on this because only DMARDs will control the disease not the diets.

    I met all the criteria above long before my rheumatologist declared that I was/am in remission. I believe he was trying to be careful on his decision to avoid any flare on me. I did/do not have any swollen joints, no pain, and my CRP and ESR were well below the normal range since long ago. He had already reduced my mtx from 20 mg to 12.5 mg now. He told me that he will continue to reduce that in another 6 months if my condition continue to be good and eventually I would keep Arava alone.

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