Is Rheumatoid Arthritis remission whatever it means to you?
I could not resist picking up the “managing arthritis” magazine last week in the rheumatology doctor’s waiting room. For some reason, I want to know what – if anything – they are telling patients who have Rheumatoid Arthritis. Is it weird how I choose that over a Woman’s Day magazine?
Right there on the cover: a Rheumatoid Arthritis remission article. What did they say? They admitted that Rheumatoid Arthritis remission is not well defined and encouraged patients to come to agreement with their doctors about what “remission means to you.” I wonder how the doctors like that.
3 Ways to look at Rheumatoid Arthritis remission & 3 descriptions of it
A definition of Rheumatoid Arthritis remission is indeed still developing. Doctors say it is exciting to be talking about since only ten percent of RA patients achieve remission naturally – without treatment. They need ways to measure remission so that they can discover whether certain treatments increase remission rates.
There is more than one way to think about RA remission. Here are three distinctions: First, many researchers are describing a state of “low disease activity” even though a more traditional designation for remission means absence of disease activity. A second distinction is whether patients are continuing treatment during the so-called remission. This is a drug-induced state of remission. Finally, the specific attributes of various definitions can be quite dissimilar.
Three lists of criteria used for remission classification are American College of Rheumatology (ACR) criteria, US FDA criteria, and criteria which uses the Disease Activity Score (DAS). It is very important to notice which criteria were used when reading a study or the claims of any medicine or regimen. The looser the criteria, the higher the remission rate.
What is interesting to me about Rheumatoid Arthritis remission?
- In an article in 2006, Dutch researchers call for keeping cure- like remissions distinct from those of comparable “low disease activity” for the purpose of research.
- They note that patients with low anti-CCP antibodies are more likely to remit naturally.
- I’ve always thought that the FDA definition sounds more like genuine remission and not a sleight of hand.
- Perhaps patients would prefer stricter criteria as much as researchers would prefer looser ones.
- “Remission rates while being treated with DMARDs are comparable with the reported natural remission rates in RA…”
- Remission rates tend to be higher with use of Biologics together with methotrexate.
I was intrigued by a tangential comment with regard to the COBRA trial: “However, almost all remissions ended after prednisone was stopped .” It sounded odd to me that any doctor would consider prednisone suppression of RA symptoms a remission. One good doctor I know calls the prednisone repression of RA symptoms a “false reality.” I’d definitely not refer to it as remission.
Read the rest of this article on Rheumatoid Arthritis remission in Arthritis Research and Therapy. It includes a table with the three sets of criteria for remission.
Has your rheumatoid doctor ever asked you what remission would mean to you? Has he told you what it means to him?
UPDATE 3/2011: Read about new remission criteria for RA: New Rheumatoid Arthritis Remission Criteria
- What is Remission of Rheumatoid Arthritis? Part 1
- Is There a Blood Test for Rheumatoid Arthritis? Part 1
- Ultrasound for Rheumatoid Arthritis, Part 1
- The Onset of Rheumatoid Arthritis Symptoms: How Does RA Begin?