RA can relapse — even after years of remission. Learn why and what you can do about it.
Thanks to newer medications and more aggressive treatment strategies, remission has become increasingly possible for people with rheumatoid arthritis. In fact, about 50 percent can now achieve remission, according to a study published in Arthritis Research & Therapy in January 2014.
For some people, though, remission doesn’t last, and there are a number of reasons why. Although some factors may be out of your control, there are ways you can help prevent am RA relapse, says Grant Louie, MD, MHS, an assistant professor of medicine in the Division of Rheumatology at Johns Hopkins Medicine.
What Is RA Remission?
Remission doesn’t mean you are cured. A good way to think of it is that your disease is under the radar, or that you have little or no disease activity. Although there’s no one clear definition, there is a set of criteria that doctors use to determine when a patient with RA achieves remission, explains Dr. Louie.
Overall, to achieve remission there must be a significant reduction in your symptoms, such as less than 30 minutes of morning stiffness and pain. But, Louie adds, your doctor must also consider a number of other factors, including:
- Physical findings. Your doctor will examine your joints for tenderness, swelling, and loss of mobility.
- Blood tests. The erythrocyte sedimentation rate (ESR) test and the C-reactive protein (CRP) test measure overall levels of inflammation in the body. The rheumatoid factor (RF) test can also measures levels of an antibody associated with rheumatoid arthritis (RA).
- Imaging tests. X-rays and MRIs can also reveal how RA has affected cartilage, bone, and joints.
Many people with RA who achieve remission experience a relapse at some point, according to a study published in 2012 in Arthritis Research & Therapy. The researchers followed 394 people with RA for two years, starting at the time they achieved remission. Over the course of the study, 50 percent of them experienced a relapse.
The researchers noted that even after many years of remission, RA could become more active.
Reasons for Relapse
When remission ends and symptoms return, several factors may be involved. One of the first things doctors usually consider is their patients’ medication.
“Sometimes patients are lulled into a false sense of security once they achieve remission,” Louie says. “They may feel that they no longer need to take their medication.” Because of that, “probably one of the highest risk factors for relapse is medical noncompliance,” he says. “Patients will self-taper or stop taking their medication altogether; then they experience a flare.”
Even if you are taking your medication correctly, however, a relapse can occur, according to a study published in the journal Rheumatology in 2012. Although biologic medications, including tumor-necrosis factor (TNF) inhibitors like adalimumab (Humira) and infliximab (Remicade), have enabled more people with RA to achieve remission, these drugs may become less effective for those who develop antibodies to them.
Also, if your doctor decreases your dosage or discontinues your medication because of a planned surgery or another illness, such as an infection, relapse can occur, according to Apostolos Kontzias, MD, a rheumatologist at the Cleveland Clinic.
Louie points out there are other factors that may reduce RA patients’ chances of achieving successful remission, including smoking, being obese, and having other health problems, all of which complicate RA treatment.
If your RA is in remission, there are ways you can help prevent a relapse. First, take your medication as directed by your doctor — even if you are feeling well, advises Louie. If you need help keeping track of your medication, he recommends using tools like a pillbox, calendar, or smartphone app.
Next, follow up with your doctor regularly. You must be closely monitored, even in remission. Let your doctor know if you notice any changes in your symptoms. He says that this could be a sign that your medication needs to be adjusted.
Some lifestyle changes also could help prevent relapse, including:
- Exercise. “Maintaining a regular exercise program is critical,” Louie says. Look for low-impact activities, like yoga, tai chi and swimming, and avoid high-impact exercises, like running, Louie says. “The stress of some repetitive activities can affect the joints and trigger a flare-up,” he explains.
- Get Immunized. Infections can lead to a flare-up of your RA symptoms, Louie says.
- Relax. Physical and emotional stress has been shown to influence RA activity, and avoiding these triggers could help prevent relapse, says Dr. Kontzias. Yoga and medication are great ways to de-stress, adds Louie. “Even though I do not like to remind patients that they have RA, it’s also mind over matter,” he says. “Patients need to pace themselves and not overdo it. Do things in small doses.”