Rheumatoid arthritis: treatment and remission

The definition of remission for people with rheumatoid arthritis (RA) has been heavily debated over the years. It has generally come to mean that you have little or no disease activity. Symptoms such as swelling, pain, and fatigue are minimal or have gone away. Your joint damage has slowed or stopped, and you have a low risk of further joint damage and loss of function.

For people with RA, experts agree that being treated early and aggressively—typically with medication—increases the chances of remission. Once you’ve achieved remission, you will still need to take medication, since RA never goes away completely.

Getting started with RA treatment

The goal of RA treatment is to halt or slow the disease, relieve pain and other symptoms, and improve function and well-being. So, your rheumatologist is likely to recommend an aggressive treatment plan from the start, often involving disease-modifying antirheumatic drugs (DMARDs). They may use conventional DMARDs, such as methotrexate, and/or biologic DMARDs, such as TNF inhibitors.

Monitoring your RA treatment progress

Aggressive treatment of RA requires frequent monitoring to check how well the treatment is working. Your rheumatologist may want to see you once a month, or every two to three months, depending on the stage of your disease and the medications you're taking.

To monitor your treatment, your rheumatologist will look at several factors and calculate a “disease activity” score. Your score tells how well your treatment is moving you toward remission. It’s based on these factors:

• How you feel. To get your opinion, your rheumatologist may ask you to fill out a written questionnaire. Written answers are less likely than verbal answers to be misinterpreted, can be more easily "scored," and can also be added to your medical records.
• How you look and sound. This is your rheumatologist’s opinion, based on what they can see at your visit.
• Blood tests. These look for signs of treatment side effects and check whether the inflammation in your body is being reduced. Specifically, they check erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) levels.
• Imaging. Your rheumatologist may schedule imaging (X-ray, MRI, CT scan, or ultrasound) to examine how treatment is affecting joint damage and erosion: Has it slowed, worsened, or stopped? This is called "monitoring the radiographic progression" of your RA. This may be done every 6 to 12 months during the first few years of rheumatoid arthritis.

Note that some health insurance companies will cover biologics only if your rheumatologist can prove that you have not responded to other medications. Regular score-based monitoring is a good way to provide evidence of your treatment history.

Is your treatment plan working?

If your RA treatment plan isn't moving you toward remission, your rheumatologist will likely adjust your medication. This may involve increasing dosages, adding a drug, or switching to a different medication. This is called treating toward a target, intensive therapy, or aggressive therapy, and it is the most effective way to treat RA.

Once you've hit your target (remission), you may be monitored less frequently. You will still need to keep an eye on your symptoms, however, and meet regularly with your healthcare team.