Remission. We all strive towards it, dream of it, wonder why we aren't there yet. When you have RA, the word remission is everywhere, but what exactly is it? How is it defined, how do you get there and what if you haven't yet seen any signs of it? To get more answers, I spoke to Dr. Yusuf Yazici, assistant professor rheumatology and head of Clinical Outcomes Research Unit at the NYU Langone Medical Center. Much of the discussion was framed by your questions.
One note: please keep in mind that the statements made in this post about treatment and remission are general ones. To discuss your specific case of RA, your treatment and questions about remission as they pertain to you, please consult your rheumatologist.
Definition of Remission
"Remission means absence of disease activity." Dr. Yazici said. In cases of RA, "spontaneous remission very rare and it happens early in the disease when the disease is not fully formed." He went on to say that "it's likely that those don't have rheumatoid arthritis, they have something else that goes into remission."
In terms of remission, Dr. Yazici stated that "currently in rheumatoid arthritis we talk about remission while you're on medication. If you stop medication, 95 percent of the time, the RA comes back." He went on to confirm the need for early, aggressive treatment, stating that those that "get on meds and respond within first 12 months have the best response."
When you treat hypertension or diabetes, a single number can be used as a measurement to indicate whether a patient is doing well. However, with RA there is no single number and rheumatologists use composite indices to measure whether a patient is in remission. This means different measures used together, such as number of swollen joints, number of tender joint and a blood tests indicating level of inflammation in the body. This is where it gets interesting and potentially little confusing, because there are five measures of remission commonly used by rheumatologists. "If someone is in remission, the next question is by which measure?" Dr. Yazici said.
Yazici went on to explain that these five common measures all have their own definition of remission and the overlap between them is approximately 80 percent. That means that although they might disagree on a few measures of remission, 80 percent of the time, they do agree. The most stringent of the measures is the new remission criteria developed by a committee of members from the American College of Rheumatology and European League Against Rheumatism (ACR/EULAR). These criteria define remission if you have
- no more than one swollen joint
- no more than one tender joint
- you rate the overall severity of your RA 10 or less on a 0-100 scale
- your sedimentation rate blood test is low (below 30 for women and 20 for men)
I asked Dr. Yazici which of the measures was most commonly used in rheumatology practice and he indicated the Disease Activity Score or DAS-28. According to this index, you can still be considered as doing well or in remission if you have a few swollen or tender joints.