Rates of Remission and Low Disease Activity
Numerous studies have found that by the ACR/EULAR definition, only 6% of people with RA experience remission. However, this measurement is very stringent. Higher rates are possible when using different, slightly more flexible criteria. Dr. Yazici mentioned that the best remission rates that are currently achieved are 40-50 percent.
Low disease activity can also be acceptable. Dr. Yazici mentioned that 15-20 percent of people who have RA also have fibromyalgia. Since fibromyalgia doesn't tend to improve to the point of remission, these individuals "will always have pain so their tender joint count will never be zero ... they'll never be in remission by that measure, but they might have no active symptoms of RA." Each case is individual and rheumatologists will therefore look at a number of factors in determining whether someone is in remission. Dr. Yazici went on to say that "well controlled RA is similar to remission in a lot of cases."
How to Get to Remission
Dr. Yazici said "the main thing is not the medication you use, but how aggressively you use it. We have to keep pushing it and evaluate the patient at least every three months and not keeping people on a medication for more than six months if they're not adequately responding to it." This is the treat to target approach, "the main movement in rheumatology these days."
Dr. Yazici went on to explain that of those that reach a target of low disease activity or remission, approximately 40 percent can do so on one medication and approximately 60 percent will require a combination of medications, usually involving Biologics. Many can manage on the same medication for long time, but "50% have to change something within 5 years or so." If they switch to another medication, it is likely that they will respond well again
About 10 percent do not respond to medication. When someone does not respond, Dr. Yazici said "it has to be carefully analyzed, because they might not be taking the maximum dose, they may not have given it enough time ... [It's a matter of] right dose, right duration, right combination."
For those who do not respond to treatment, Dr. Yazici offers the hope of new medications being developed. "There are at least two more medication coming out in the next two years." He explained that the present Biologics target certain molecules, but current medications don't target everything - "there are six or seven new molecules being discussed and it's our hope that those people who are not responding to current therapies will respond to the new ones."
Our thanks to Dr. Yazici for taking the time to share information about remission and the reasons to hope for the future.
Lene is the author of the award-winning blog The Seated View.