Tuesday, January 31, 2023

Does Rheumatoid Arthritis Go Into Remission

Why Your Ra Went Into Remission But Relapsed

Things Will Never Be the Same —RA Remission Vlog—

You may achieve remission, but it doesnt always last. Heres a look at why and what you can do to keep symptoms at bay.

Many people with rheumatoid arthritis can silence their symptoms and halt progression of the disease thanks to biologic medications and more aggressive treatment approaches. Yet some patients who achieve remission struggle to sustain it, research shows. In a 2012 study published in Arthritis Research & Therapy, doctors at Brigham and Womens Hospital in Boston tracked the progress of 394 RA patients from the time their disease went into remission. A year later, half of the patients had relapsed at some point. Researchers checked on the patients after another year and found that only about one-quarter of the relapsed patients had returned to a state of remission.

Defining Remission

Remission means different things to different people. To some its the total absence of symptoms, while other patients might feel their RA is in remission if they have only an occasional flare of joint tenderness or morning stiffness. The American College of Rheumatology has published specific criteria for defining RA remission. Regardless of how you define remission, theres little ambiguity when a relapse occurs: symptoms you once had under control return, your quality of life diminishes and damage to your joints could be worsening. Understanding why relapses occur may help you maintain remission or quickly recover if you have a setback.

Switching RA Medications May Help

Early Treatment And Treat

It is indisputable that treatment should be started as early as possible so as to take advantage of the early period of the disease when underlying inflammation is more susceptible to immunomodulatory treatment than at later time-points, something that has been shown irrespective of therapy. There are new classification criteria for RA enabling earlier diagnosis of the disease, and even recommendations for management of early arthritis. However, in real life, there is still significant delay between symptom start and referral to rheumatologist, making early intervention difficult.

It is also widely accepted that the goal of RA treatment today should be achieving a state of minimum or no disease activity, that is, remission. Attaining remission minimises joint destruction, improves physical function and quality of life, increases work capacity, and reduces risks for comorbidities, such as cardiovascular comorbidities. In some patients, especially those with long-standing disease or difficult-to-treat, refractory disease, remission might be impossible and low disease activity might be a more realistic goal. Sustained remission is the logical next goal, especially if this can be achieved in the context of drug discontinuation, the so-called drug-free remission.

What Does It Take To Achieve Remission For Rheumatoid Arthritis

Typically, a combination of medication and lifestyle changes are needed in order to achieve remission, but the exact requirements for achieving remission wont be the same from person to person.

Some people may have one medication and theyre in remission, some people may need three medications and theyre in remission, Dr. Koumpouras says, adding that when people are able to achieve remission, it typically takes at least six months of treatment.

Medications for rheumatoid arthritis come in many forms and typically work by lowering levels of inflammation in your body, Dr. DiRenzo explains. One type of medication thats frequently used is a class of drugs called disease-modifying antirheumatic drugs , which slow the progression of the disease. If conventional DMARDs arent working well enough, your doctor may prescribe a type of drug called biologics or biologic DMARDs. These are injected and designed to target specific parts of the immune system that contribute to inflammation. Keep in mind that your treatment options may change over time based on new research and newly available therapies. Make sure you have ongoing conversations with your doctor about which treatment options may be best for you.

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Question: Can Ra Go Away On Its Own

For most, rheumatoid arthritis is a chronic progressive illness, but about 5%-10% of people experience remission without treatment. This is uncommon, however, after the first three to six months. Rheumatoid arthritis is not fatal, but complications of the disease shorten life span by a few years in some individuals.

Your Lifestyle Habits Can Affect Remission Too

Does Rheumatoid Arthritis Really Go Into Remission During ...

While the right medication plan is often the most important part of getting to and staying in remission, other factors can play a role as well. A studypresented at the annual meeting of the American College of Rheumatology in 2018 found that for women, being obese more than doubled the risk of not achieving remission within 12 months. For men, current smokers were 3.5 times less likely to reach remission. Stress may play a role too, says Dr. Domingues, who advises trying to be aware of your stress levels and when they feel out of control for you. Its easy to say, hard to do, he acknowledges.

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Can The Rheumatoid Arthritis Go Into Remission

I always thought that remission was like the Holy Grail hard to come by. However, I never realized that it was also hard to identify.

When somebody has cancer, he fights for remission. His whole family prays for remission. The remission itself may be elusive, but he knows what it is! It is no more cancer. At least for the time being

It is not so with Rheumatoid Arthritis. They havent really decided what it is. Look at what one rheumatologist said: To a considerable extent, defining remission in RA is like defining pornography we have great difficulty agreeing on a definition.

Many Factors Influence How Likely You Are To Experience Ra Remission

According to Ashira Blazer, MD, a rheumatologist and an assistant professor of medicine at the NYU Grossman School of Medicine in New York City, your chances of experiencing remission depend on a number of things, including:

  • How soon you are diagnosed after the disease begins and how quickly you begin drug treatment .
  • How many joints are tender and swollen when you are first diagnosed .
  • Your blood levels of certain proteins that indicate whole-body inflammation, namely ESR and CRP .
  • Whether you have certain inflammatory markers associated with the disease, including rheumatoid factor , or the antibody known as anti-cyclic citrullinated protein . People without RF or ACPA those who have so-called seronegative rheumatoid arthritis have a greater chance of remission.
  • Whether or not bony damage from RA can be seen on X-rays when you are first diagnosed. Your physician will determine joint damage by performing periodic X-rays to look for changes in the bones closest to the joints.

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Continue Learning About Rheumatoid Arthritis

Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.

So What Does Rheumatoid Arthritis Do After Pregnancy

Sustained Remission with Etanercept Tapering in Early Rheumatoid Arthritis

For me its been good! But remember, everyones body is different! Whether you breastfeed or not, or depending on what type of delivery you have, can play a huge role in arthritis after pregnancy! Make sure to check in with your doctor for anything relating to rheumatoid arthritis!

If you have any questions, feel free to ask me anything!!

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Remission Isnt The Same As A Cure

Being in remission from rheumatoid arthritis doesnt mean you no longer have the illness, which means that relapse is a possibility.

Unfortunately, with all autoimmune diseases including rheumatoid arthritis, flares and high disease activity can occur throughout ones lifetime, Dr. DiRenzo says.

Many times this is brought about by a medication change, such as if the patient stops taking their medication or if the rheumatologist reduces the amount of medication the patient is taking. There are also some conditions where people experience what they call a flare or an exacerbation, Dr. Koumpouras says, explaining that an injury, infection, or some other form of trauma or event can heighten the amount of inflammation in someones body.

Rheumatoid arthritis is a complicated disease and isnt the type of illness you can try to tackle on your own. The best way to work toward remission and stay in remission is to find a doctor you trust and check in with them regularly for guidance and help in managing your care.

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Other Immunomodulatory And Cytotoxic Agents

Some additional immunomodulatory drugs are used in RA including azathioprine , and cyclosporin A . Rarely cyclophosphamide and d-Penicillamine are used. Because the potential of high toxicity, these agents are typically utilized for life-threatening extra-articular manifestations of RA such as systemic vasculitis or with severe articular disease that is refractory to other therapy.

Azathioprine has some activity in rheumatoid arthritis but may take 8-12 weeks to see an effect. It is a purine analog that can cause bone marrow suppression and lowering of blood cell counts particularly in patients with renal insufficiency or when used concomitantly with allopurinol or ACE inhibitors. Increased risk of secondary malignancy due to azathioprine is controversial. Screening for levels of the enzyme thiopurine methyltransferase is recommended before initiating therapy with azathioprine. Certain individuals have deficiencies in this enzyme that metabolizes azathioprine with a concomitantly increased risk of toxicitiy for the medication. Side effects include nausea, and alopecia. Blood tests to monitor blood counts and liver function tests are necessary for patients on azathioprine.

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How Many Ra Patients Go Into Remission

That depends upon who you ask.

According to NIH, rates of remission of Rheumatoid Arthritis vary from under 5% to over 16% because of differing definitions. Those ranges are substantiated by much of what I have read. One study reported on Medscape says the remission rate can be up to 20% using certain criteria. Compare that to what one doctor said in Arthritis Today: If you get treated within two years of the onset of RA symptoms, you have more than a 50 percent chance of achieving remission.

Is he saying that over half of those who are treated early will get remission?

Alas, I am not a doctor. But, I have read dozens of abstracts and detailed reports on remission. I have never read anything like that, however he qualifies it.

It also depends upon how you ask.

There are various sets of criteria which fulfill various definitions of remission. NIH concluded: The use of different definitions of RA remission leads to different results with regard to remission rates

Diagnosis And Management Of Rheumatoid Arthritis

How Is Seropositive Rheumatoid Arthritis Diagnosed?

J. ADAM RINDFLEISCH, M.D., and DANIEL MULLER, M.D., PH.D.

University of WisconsinMadison, Madison, Wisconsin

Am Fam Physician. 2005 Sep 15 72:1037-1047.

Patient information: See related handout on rheumatoid arthritis, written by the authors of this article.

Rheumatoid arthritis is characterized by persistent joint synovial tissue inflammation. Over time, bone erosion, destruction of cartilage, and complete loss of joint integrity can occur. Eventually, multiple organ systems may be affected.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Patients with rheumatoid arthritis should be treated as early as possible with DMARDs to control symptoms and delay disease progression.

DMARD = disease-modifying antirheumatic drug NSAID = nonsteroidal anti-inflammatory drug.

A = consistent, good-quality patient-oriented evidence B = inconsistent or limited-quality patient-oriented evidence C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, see page 983 or

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Patients with rheumatoid arthritis should be treated as early as possible with DMARDs to control symptoms and delay disease progression.

DMARD = disease-modifying antirheumatic drug NSAID = nonsteroidal anti-inflammatory drug.

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Requirements For Ra Remission

  • Less than 15 minutes of stiffness upon awakening in the morning
  • Little or no joint pain, tenderness, or swelling
  • Blood tests showing low levels of inflammation

Remission means that your symptoms have resolved and disease activity has stopped. Little or no disease activity translates into no continuing or lasting joint damage.

Treating Disease Early And Aggressively Helps Patients Enter Remission

As noted above, spontaneous remission in inflammatory arthritis is rare. Patients who get their arthritis into remission usually are on a disease-modifying medication , and often a combination of disease-modifying medications, within the first six months after being diagnosed.

While you have a lot of information to process after youve just been diagnosed with a disease like rheumatoid arthritis, its important to move swiftly and start medication to increase your chances of getting to remission. Research shows achieving remission is less common among people with long-established disease.

In large cohort studies, the frequency of remission at a given time is around 20 percent. It is known to be easier to achieve remission using intensive, treat-to-target treatment strategies using todays medications. Such patients may achieve remission up to 50 to 70 percent of the time, says Dr. Davis.

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Here Are Some Things That Are Helping Keep Rheumatoid Arthritis Away After Pregnancy:

Im still breastfeeding. There was a time around month two I didnt think I could continue because of the severe pain and complications we continued to have. But I kept going, and we are still going strong! Hormones are similar to pregnancy during breastfeeding, so I think this has helped with my auto-immune response. Breastfeeding has been the hardest part for us. It is an entirely different article though! If you would like me to share that, please let me know

Exercise and healthy living! I had to rest for 8 weeks after surgery, but got right back into exercise. I walked and stayed active all through pregnancy . Exercise helps in so many ways for RA in general, but especially after pregnancy. The endorphins help your mood, it helps get pregnancy weight off which helps joints, and it keeps everything mobile.

I also eat healthy! Fruits, vegetables, fish, chicken, whole grains, and healthy fats are the majority of my diet. Not only is this good for breastfeeding, but also good for arthritis! I follow many of these tips on dealing with an arthritic flare.

The biggest thing is praying and trusting God to keep this Rheumatoid arthritis away. I was worried what it would be like to take care of a baby while having an arthritic flare in my elbows and knees. Instead, I just have faith and trust, knowing He will get me through!

Clinical Course And Sustained Remission In Rheumatoid Arthritis

Why Certain Diseases Go Away During Pregnancy? â Dr.Berg

Systemic Autoimmune Disease Section, Internal Medicine Department, Hospital Provincial del Centenario, Universidad Nacional de Rosario, Argentina

*Corresponding author: Mariana Lagrutta, Systemic Autoimmune Disease Section, Internal Medicine Department, Hospital Provincial del Centenario, Universidad Nacional de Rosario, Rosario, Santa Fe, Argentina.

Citation: Lagrutta M, Parodi RL, Greca AA Clinical Course and Sustained Remission in Rheumatoid Arthritis. J Musculoskelet Disord Treat 4:053. doi.org/10.23937/2572-3243.1510053

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What Is Sustained Dmard

Once a good response on DMARDs and stable remission are achieved, the treatment could be tapered and once remission is further sustained, the treatment could be stopped. Drug-free remission has been described in several patient groups which supports that drug-free remission could truly be achieved.

The approach of benefit/risk assessment of continuation or stopping DMARDs was examined as early as the 1990s in a double-blind placebo-controlled study. In this study, RA patients with a good long-term therapeutic response, after median duration of DMARD therapy of 5 years, were randomized to continue therapy, n = 142, or to receive placebo, n = 143. At 52 weeks of follow up, as many as 62% of the patients who were randomized to placebo and 78% of the patients who were randomized to continue therapy did not have a flare, defined as recurrence of synovitis. Side-effects that necessitated dose reduction or discontinuation occurred equally in each group.

You Can Still Have Flares And Pain While Youre In Remission

Being in remission in RA doesnt necessarily mean you no longer have pain or discomfort. You can have intermittent bouts of flares or pain while youre in remission. Often a short course of steroids can be enough to stop the flare, and then you go back to a cycle of maintenance, says Dr. Domingues. It is common, and patients should not be discouraged about that.

Also, co-occurring diseases are common among inflammatory arthritis patients, notes Dr. Domingues. If patients have disease activity scores that indicate low levels of inflammation and few affected joints, but are still experiencing pain, this could indicate other diseases such as fibromyalgia or osteoarthritis. We need to understand exactly the culprit for your pain, because the treatment is very different for fibromyalgia than for rheumatoid arthritis than for osteoarthritis, Dr. Domingues explains.

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I Asked Her Right Away Isnt This Ra Going Into Remission Soon

She said, not everyone goes into remission. The majority of her patients do NOT! I was surprised to hear this because everything I had read online to this point always showed the majority of women getting into remission during pregnancy.

I really didnt want to be on medication during pregnancy to be safe for the baby, but she said I could take a small dose of prednisone while this flare lasted. There are other medications to take if it becomes unbearable, but steroids were the safest option.

The next day I went to my OBGYN to talk with her about it. She said steroids are usually safe, but there is a small possibility of physical defects to the face.

The minute I heard this, I said NOPE, I wont risk anything to my little girl.

So, I talked with my husband about it and we decided to pray and trust God to get me through the pain. It isnt worth risking anything to the baby.

What Does It Mean To Be In Remission From Rheumatoid Arthritis

What Does Rheumatoid Arthritis Do After Pregnancy?

If you or someone you love has rheumatoid arthritis, youve probably thought about remission from rheumatoid arthritis more than once. As you likely know, rheumatoid arthritis is a very serious illness, and it can often be debilitating. So the concept of achieving remission can feel like a beacon of hope.

Today more than 1.3 million Americans are living with rheumatoid arthritis, and about 75 percent of them are women, according to the American College of Rheumatology. Rheumatoid arthritis is the most common form of autoimmune arthritis and causes pain, stiffness, and swelling in the joints of the hands, feet, and wrists.

As a quick refresher: Autoimmune diseases like rheumatoid arthritis arise when the bodys immune systemwhich typically keeps you healthy and defends against diseasestops working properly and mistakenly attacks healthy cells in your body, according to the U.S. National Library of Medicine. But with new advances in treatment options, it is possible to stop or slow the progression of rheumatoid arthritis with the right treatment. In some cases, people are even able to achieve a state of remission where the joints arent seeing further damage and the disease doesnt interfere with day-to-day living. Heres what you need to know about achieving rheumatoid arthritis remission.

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