6 Essential Facts About Rheumatoid Arthritis Remission
While remission is one of the main goals of rheumatoid arthritis treatment, there’s a lot about it that’s misunderstood. Find out what you need to know.
There’s no cure for rheumatoid arthritis (RA), a chronic, inflammatory type of arthritis. But it is possible to achieve remission, a period when your condition is well controlled.
With remission, you may feel as if your RA has gone away, at least for a while. “That is actually our goal: to be in remission,” says Orrin Troum, MD, a rheumatologist at Providence Saint John’s Health Center in Santa Monica, California.
Achieving this goal can be more challenging for some people who have RA than others, and rates of remission can vary. One study of people with late-onset RA and younger-onset RA found that both groups had a similar time to remission, and that 72 percent of later-onset patients and 78 percent of younger-onset patients reached remission. Another study, which followed 444 patients for a year, found that about 30 to 51 percent achieved remission, depending on how remission was defined.
Here are some facts about RA remission to keep in mind.
1. Remission Doesn’t Mean Your Symptoms Disappear Completely
When your RA symptoms appear to be in check and you feel good, it may seem like an obvious sign of remission. But from a medical standpoint, remission is a little more complex.
In the 1980s, remission was defined as the elimination of all RA disease activity. But in practice, this definition wasn’t a realistic goal.
Today, remission is defined as a limited or small amount of disease, according to the Arthritis Foundation.
The American College of Rheumatology (ACR) and the European Alliance of Associations for Rheumatology (EULAR) endorsed a number of criteria, used by scientists when conducting clinical trials, to determine if RA is in remission. These can include a combination of:
No more than one tender joint
No more than one swollen joint
A blood test showing little or no inflammation
Your perception of your disease activity
But your rheumatologist may not necessarily use this system in an office setting. “Some remission definitions have to do with the person’s subjective feelings,” adds Dr. Troum.
For example, your rheumatologist may ask you to describe your RA on a scale of 1 to 10, with 10 being the most bothersome. “Even though a person may not have any tender or swollen joints and their tests for inflammation are normal, if they say they’re a 3 on the scale, they may not be in remission,” says Troum.
2. The Length of Remission Can Vary Dramatically
Although the goal is to maintain remission for as long as possible, the length of it varies by person, according to Troum. Remission can last for months or even years, notes Arthritis Society Canada, and over 20 percent of people in remission may have a flare in a given year. According to the Arthritis Foundation, about a third of people have alternating periods of remission and relapse, regardless of what therapy they’re on.
3. The Sooner You Start Treatment, the Greater Your Odds of Achieving Remission
When RA is treated early, soon after diagnosis, with medications called disease-modifying antirheumatic drugs (DMARDs) and biologics, the chances of achieving remission increase.
“You typically need to have symptoms for at least six weeks to make the diagnosis, but the earlier you get diagnosed, the less damage will be done,” Troum says. “As soon as you can control the inflammation, you can prevent the changes in the joints from progressing.”
4. A Combination of Medication and Lifestyle Can Help You Maintain Remission
The most important step in maintaining remission is to stick to your treatment plan and take your medication exactly as prescribed.
In addition to early diagnosis and treatment with DMARDs, frequent assessments of disease activity (typically every three months) with adjustments in medication as needed can help most people with RA achieve remission or low disease activity, according to research.
That said, your lifestyle also plays a role. Some ways to maintain remission:
Don’t smoke. In a study, 47 percent of people living with RA who took a DMARD called methotrexate — and who were also current smokers — had an inadequate response to the drug, meaning they still had high disease activity.
Stay active. Exercise is beneficial for everyone, but especially when you have RA. Low-impact activities like walking, biking, swimming, and yoga can all be good options that won’t stress your joints. “Whatever exercise you can and will do, can help you,” says Troum.
Eat healthy. An anti-inflammatory eating plan, such as the Mediterranean diet, can help reduce inflammation in your body that otherwise contributes to RA. This means focusing on fruits, vegetables, whole grains, lean meats, and healthy fats such as those in fish and olive oil.
Keep other health conditions in check. In addition to taking care of your joints, it’s important to take care of the rest of your body. If you have another health condition, such as diabetes or heart disease, make sure you’re getting the right treatment. “Keeping all your organs as healthy as possible will also help you,” Troum says.
Certain supplements may also reduce inflammation, such as high-dose omega-3 fatty acids or turmeric, according to Troum. If you’re interested in taking supplements for your RA, talk to your rheumatologist first.
5. You May Be Able to Cut Back on Your Meds When You Reach Remission
You may be able to start taking a lower dose of your medication once you’ve been in remission for at least six months, under your doctor’s guidance. That said, you probably won’t be able to go off all medications — particularly DMARDs, says Troum.
“Sometimes, people are on two or three meds for their arthritis, and yes, they can taper down some,” he says. But the DMARD you take, whether it’s a traditional DMARD, a biologic, or a janus kinase (JAK) inhibitor, is what’s keeping you in remission. “You usually need to stay on that or switch to [another DMARD] that will keep you in remission,” Troum notes.
Work with your doctor to determine if you’re able to taper your RA medication during remission.
6. Relapses Are Common
Some patients who achieve remission relapse when they discontinue their biologic medications. Relapses can also happen if you’re doing everything exactly as you should, because your body can become resistant to a particular medication you’re on.
Your doctor will want to confirm you’re taking your medication consistently and correctly. If you are, but are still relapsed, you may need to switch to a different DMARD to regain control of your symptoms. “Different biologics have different mechanisms of action, as do JAK inhibitors,” Troum says.
If you have a flare-up, notify your rheumatologist right away so you can take steps to adjust your treatment plan and, ideally, regain remission.
The Takeaway
Achieving rheumatoid arthritis remission is possible, but your symptoms may not disappear completely, and flares can still occur.
Starting RA treatment early with disease-modifying antirheumatic drugs (DMARDs) boosts the chance of achieving remission.
A combination of consistent medication management and lifestyle changes, such as not smoking, staying active, and eating an anti-inflammatory diet, can help maintain remission in RA.
Relapses are common and may require adjustments in medication; always consult a healthcare professional if symptoms return or changes in treatment are needed.
EDITORIAL SOURCES
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Resources
Li X et al. Late-Onset Rheumatoid Arthritis Has a Similar Time to Remission as Younger-Onset Rheumatoid Arthritis: Results from the Ontario Best Practices Research Initiative. Arthritis Research & Therapy. November 19, 2022.
Al-Saleh J et al. Prevalence and Predictors of Remission and Sustained Remission in Patients with Rheumatoid Arthritis from the United Arab Emirates: A Two-Year Prospective Study. Open Access Rheumatology. May 10, 2023.
Studenic P et al. American College of Rheumatology/EULAR Remission Criteria for Rheumatoid Arthritis: 2022 Revision. Annals of the Rheumatic Diseases. 2023.
Mysler E et al. Current and Emerging DMARDs for the Treatment of Rheumatoid Arthritis. Open Access Rheumatology. June 1, 2021.
Floris A et al. Current Smoking Predicts Inadequate Response to Methotrexate Monotherapy in Rheumatoid Arthritis Patients Naïve to DMARDs: Results from a Retrospective Cohort Study. Medicine. April 30, 2021.
Kemble S et al. Critical Role of Synovial Tissue–Resident Macrophage and Fibroblast Subsets in the Persistence of Joint Inflammation. Frontiers in Immunology. September 3, 2021.
Chen D et al. Dosing Down and Then Discontinuing Biologic Therapy in Rheumatoid Arthritis: A Review of the Literature. International Journal of Rheumatic Diseases. February 2018.
Beth Biggee, MD, is medical director and an integrative rheumatologist at Rheumission, a virtual integrative rheumatology practice for people residing in California and Pennsylvania. This first-of-its-kind company offers whole person autoimmune care by a team of integrative rheumatologists, lifestyle medicine practitioners, autoimmune dietitians, psychologists, and care coordinators.
Dr. Biggee also works as a healthcare wellness consultant for Synergy Wellness Center in Hudson, Massachusetts. Teamed with Synergy, she provides in-person lifestyle medicine and holistic consults, and contributes to employee workplace wellness programs. She has over 20 years of experience in rheumatology and holds board certifications in rheumatology and integrative and lifestyle medicine. Dr. Biggee brings a human-centered approach to wellness rather than focusing solely on diseases.
Dr. Biggee graduated cum laude with a bachelor's degree from Canisius College, and graduated magna cum laude and as valedictorian from SUNY Health Science Center at Syracuse Medical School. She completed her internship and residency in internal medicine at Yale New Haven Hospital, completed her fellowship in rheumatology at Tufts–New England Medical Center, and completed training in integrative rheumatology at the University of Arizona Andrew Weil Center for Integrative Medicine. Following her training, she attained board certification in rheumatology and internal medicine through the American Board of Internal Medicine, attained board certification in integrative medicine through the American Board of Physician Specialties, and attained accreditation as a certified lifestyle medicine physician through the American College of Lifestyle Medicine. She is certified in Helms auricular acupuncture and is currently completing coursework for the Aloha Ayurveda integrative medicine course for physicians.
In prior roles, Dr. Biggee taught as an assistant clinical professor of medicine at Mary Imogene Bassett Hospital (an affiliate of Columbia University). She was also clinical associate of medicine at Tufts University School of Medicine and instructed "introduction to clinical medicine" for medical students at Tufts. She was preceptor for the Lawrence General Hospital Family Medicine Residency.
Dr. Biggee has published in Annals of Rheumatic Diseases, Arthritis in Rheumatism, Current Opinions in Rheumatology, Journal for Musculoskeletal Medicine, Medicine and Health Rhode Island, and Field Guide to Internal Medicine.
Erica Patino is a freelance writer and editor, content strategist, and usability specialist who has worked for a variety of online health outlets, including Healthline, Sharecare, and Twill Care. She was previously a senior editor at Everyday Health. She is also the founder and editor-in-chief of Hear 2 Tell, a website that covers advances in hearing loss treatment. Patino lives in Portland, Oregon, with her husband and twin sons.
