People with rheumatoid arthritis (RA) can suffer permanent joint damage as early as into the first six months of the disease. As a result, many rheumatologists believe early and aggressive treatment is the best approach to managing rheumatoid arthritis. Many also prescribe to a theory that today’s newer RA medications along with older ones can allow at least half of the people with RA to achieve remission.
What is rheumatoid arthritis remission?
The term remission is defined as a period when disease symptoms are greatly reduced or no longer apparent. For rheumatoid arthritis patients, clinical remission is when all or most of the symptoms, such as fatigue, pain and inflammation, of RA have gone and damage to joints has stopped.
The American College of Rheumatology has several critical factors that determine whether a patient is in clinical remission from rheumatoid arthritis. These are:
- Morning stiffness for less than or equal to fifteen minutes;
- No fatigue;
- No joint pain;
- No joint tenderness or pain with movement;
- No tissue swelling in joints and tendons; and
- An ESR or erythrocyte sedimentation rate (blood test to measure inflammation) less than 30 in men and less than 20 in women.
Achieving Remission by Treating Early and Aggressively
Early and aggressive treatment is not a new concept. In fact, it goes back to the late 1980s when the Lancet published a study that promoted starting anti-rheumatic drugs early. That study, according to the National Institutes for Health, looked at medications that were on the market at the time, including Plaquenil (Hydroxychlorquine) and Azulfidine (sulfasalazine). Methotrexate and biologic agents were not yet available. The main difference between the current theory and 1989 study is just in the types of drugs used in treatment but essentially the idea is the same. An alternative study looked at 92 medical centers in Australia and Europe wherein three quarters of those treated with a combination of methotrexate and Enbrel experienced no advancement of joint damage by the three year mark and more than 40 percent achieved clinical remission.
Remission is the best outcome when RA patients treat early and aggressively. Further, disease advancement can be stopped before joint damage occurs. For patients who do not experience remission, there is still a potential for major improvement of RA symptoms and low disease activity.
For patients who have the potential to develop a more serious form of rheumatoid arthritis, early and aggressive treatment is vital. Because doctors do not know who these patients are, they must take the presumption that joint damage and severe disease activity is possible for all patients.
What Does This Mean for You?
A major goal of disease management is to begin treatment as soon as possible in order to prevent damage to joints and allow patients the best chance of achieving and staying in remission. Through available research, doctors and patients know that treating early and before damage occurs, patients have a higher probability of achieving remission. Further, if RA is treated aggressively, the chances of remission are even greater.
Most RA patients who are treating with methotrexate and biologics are already experiencing low or moderate disease activity. As the patient, make it a point to talk to your doctor if you are still experiencing disease activity. Trying a higher dose of your current medication or even a different medication may get you in the right direction. If you are seeing major improvement in symptoms and low disease activity, you are much closer than you think.