“Can RA go into complete remission or disappear completely? I tested positive for RA factor as a teen in the 1970s with exacerbations through my mid-20s. In my late 50s, the RA factor test was repeated and came back negative.” — Rheumatoid Remission
Dear Rheumatoid Remission,
Remission is the Holy Grail for all of us who live with rheumatoid arthritis (RA). Remission means no more pain, no more damage to your body, and going back to living a normal life. As with many such lofty goals, there are misconceptions about remission, how to get there, and how to stay there.
What is RA?
RA is a chronic autoimmune disease. It is most known for affecting the joints, but it is a systemic condition. That means it affects multiple systems in your body, including joints, internal organs, vascular system and more. RA is also progressive. When left untreated, it causes damage to these systems. This can lead to joint deformities and disability, as well as an increased risk of heart attack and stroke due to systemic inflammation.
What is rheumatoid factor?
Rheumatoid factor (RF) is a blood test that measures certain proteins or antibodies that can attack the tissues in your body. This test used to be the determining factor in whether someone was diagnosed with zero positive or seronegative RA. However, seroposivity is now determined by the Anti-CCP test, measuring anti-cyclic citrullinated peptides in the blood.
When RF is positive, it most often happens in autoimmune conditions, especially rheumatoid arthritis and Sjögren’s syndrome. “It’s about 70-80 percent sensitive for this condition,“ explained Dr. Alireza Meysami, senior staff rheumatologist at the Henry Ford Health System in Michigan, and clinical assistant and professor of medicine at Wayne State University School of Medicine. “The presence of this actually shows there is more severe disease.”
People whose RF is negative are diagnosed with seronegative rheumatoid arthritis.
Dr. Meysami clarified that: “The test is also only 80-85 percent specific. Some of these patients could have other diseases than rheumatoid arthritis.”
He continued that these could include infection, which can sometimes cause RF positivity, or other rheumatic diseases. Additionally, changes in RF do not “correlate with disease activity at all,” that is: Any change from positive to negative or vice versa does not indicate that the RA has disappeared.
In the past 20 years, there have been significant advances in treatment leading to many more individuals with RA experiencing remission.
RA remission is most often facilitated by medication, such as disease modifying antirheumatic drugs (DMARDs) and biologics. Rates of remission when taking medication can vary depending on the tool that is used to measure disease activity, but have been estimated to be around 40-50 percent. Low disease activity may also be an acceptable goal.
Drug-free remission is rare and usually temporary. An overview of several studies revealed that only approximately 9-15 percent of individuals with early RA will be able to experience sustained medication-free remission.
Once remission has been achieved through treatment, removing the medication or tapering to a lower dose may be possible for some people. Dr. Meysami explained that studies indicate that “tapering down is probably okay, but stopping was not recommended.”
In his own practice, he will taper a patient “if somebody is in remission for one year with no disease activity.” In his personal experience, approximately 60 percent of these patients remain in remission, while the rest will need to resume treatment with medication.
If you have been in remission for an extended time and want to try tapering, discuss this with your rheumatologist. Keep in mind that it’s important for your doctor to continue monitoring your health, as some RA symptoms can be systemic and therefore hardly noticeable.
You should know: The answer above provides general health information that is not intended to replace medical advice or treatment recommendations from a qualified healthcare professional.