Sustained Rheumatoid Arthritis Remission Is Rare

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Headlines can have a curious effect. They’re supposed to make you read a story, but people don’t always read the whole thing. Sometimes they just make you laugh: Lung Cancer in Women Mushrooms, Miners Refuse to Work After Death, Woman Improving After Fatal Crash. 1
With medical topics, a headline rarely tells the whole story. Nevertheless, headlines are quoted and soon become accepted facts. Then they are repeated, no questions asked.
bridge headline

Is Rheumatoid Disease remission common, rare, easy, or hard?

We won’t examine remission fully today so you might read some other warrior articles about Rheumatoid Arthritis remission. Remission definitions are variable and criteria subjective. All this leads to the current state of affairs with RA remission:

  1. Surveys of large RA populations demonstrate that remission is rare.
  2. Some small European studies claim Rheumatoid Arthritis remission is common and achieved without much difficulty.
  3. A public (including healthcare professionals) sees advertisements which insinuate that treatment allows most people with RA to live a completely normal life.
  4. Most significant of all, almost every patient receiving the label clinical remission actually experiences damaging disease activity in joints and possibly elsewhere.

Sustained remission Rheumatoid Arthritis study

Into this mess enters a new take on Rheumatoid Arthritis remission: calculating sustained remission. This new study considers changes in disease activity over time. The study Sustained rheumatoid arthritis remission is uncommon in clinical practice concluded that “in clinical practice a minority of RA patients are in sustained remission.”

The study authors recognize the value of sustained remission, suggesting that sustained remission might be necessary for actual cessation of damaging disease activity and would be preferable to “drug-induced disease suppression” often identified as remission.

Let’s adjudicate remission when three things are understood.

1) An accurate, consistent measure of disease activity is required. It must include joint activity that is invisible to the naked eye and recognize disease activity taking place outside of joints. It should not rely upon blood tests which are typically “normal” in 30 to 40% of patients (due to genetic tendencies).

2) Patterns of disease must be documented and accounted for in measures of remission or disease activity. Although no two patients are identical, many patients experience a flaring disease pattern and others constant disease activity. When patients are examined on Day One and Day 168 of a study, it may not be possible to identify flares that occurred in the interim or current disease pattern. In trials for medications, there is no representative “untreated” group to compare disease patterns.

3) Clinical trials may not apply to the wider population. They may achieve high percentage of disease remission using small numbers of patients who may be unrepresentative of the general RA population for various reasons. Some provide more early or aggressive treatment. Others use exclusion criteria to identify likely responders (i.e.: excluding complicated disease with extra-articular RA, common additional diagnoses like fibromyalgia, or normal blood values such as CRP).

Talking about sustained remission matters

We know that natural RA remission is rare and a majority of patients do not have a thorough lasting response to the routine treatment methods of today. In this case, I hope this headline is repeated. While it’s not very witty, recognizing the facts is necessary before the status quo can be improved; and this study is a step in that direction.

1More  amusing headlines.

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Kelly Young. All rights reserved.

This entry was posted on Friday, March 30th, 2012 at 5:00 am and is filed under RA Research, Resources, and Rheumatology. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.


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