6 ESSENTIAL FACTS ABOUT RHEUMATOID ARTHRITIS REMISSION

Theres 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 Johns Health Center in Santa Monica, California.

Here are some facts about RA remission to keep in mind.

1. Remission Doesnt 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 wasnt a realistic goal.

• 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 persons 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 theyre a 3 on the scale, they may not be in remission, says Troum.

2. The Length of Remission Can Vary Dramatically

3. The Sooner You Start Treatment, the Greater Your Odds of Achieving Remission

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.

That said, your lifestyle also plays a role. Some ways to maintain remission:

• Dont 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 wont 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, its important to take care of the rest of your body. If you have another health condition, such as diabetes or heart disease, make sure youre 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 youre 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 youve been in remission for at least six months, under your doctors guidance. That said, you probably wont 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 its a traditional DMARD, a biologic, or a janus kinase (JAK) inhibitor, is whats 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 youre able to taper your RA medication during remission.

6. Relapses Are Common

Your doctor will want to confirm youre 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.