We enlisted the help of a rheumatologist, Scott J. Zashin, M.D., to answer our questions about arthritis remission. His answers help clarify the concept of remission and help you recognize if you have experienced a remission.
We asked Dr. Zashin what defines a true remission in rheumatoid arthritis patients? Can a doctor predict if a patient will go in to a remission or how long a remission will last? Are there statistics on what percentage of rheumatoid arthritis patients ever achieve a remission? What can a rheumatoid arthritis patient do that will give them the best chance at achieving remission?
According to Dr. Zashin:
While there is no known cure for rheumatoid arthritis, up to 30% of patients may feel they are "cured" of their disease. What these patients are actually experiencing is a clinical remission. A remission in rheumatoid arthritis is defined as the absence of clinical signs of inflammation. While a very small percentage of patients may be able to discontinue their arthritis medications, more than 95% need to continue on their medication to remain in remission.
The American College of Rheumatology (ACR) classification criteria for determining clinical remission include:
- morning stiffness less than or equal to 15 minutes
- no fatigue
- no joint pain
- no joint tenderness or pain on motion
- no soft tissue swelling in joints or tendon sheaths
- erythrocyte sedimentation rate (a blood test which measures inflammation) less than or equal to 30 in females and 20 in males
Dr. Zashin continues:
While there is no way to determine who will achieve remission with therapy, patients with a negative rheumatoid factor and CCP antibody as well as a normal C-reactive protein (another measure of inflammation in the blood) appear to have a better outcome. In addition, patients taking combination therapy (for example, methotrexate and a TNF inhibitor) are more likely to achieve remission than those taking either drug alone. Nevertheless, patients on monotherapy (one drug alone) still may achieve clinical remission. The longer the disease remains in remission, the less likely it is to become active again.
Dr. Zashin is a clinical assistant professor at University of Texas Southwestern Medical School and an attending physician at Presbyterian Hospitals of Dallas and Plano. Dr. Zashin is author of Arthritis Without Pain - The Miracle Of TNF Blockers. The book is useful for anyone on one of the biologic drugs or considering biologic drugs.