What is a remission? | Arthritis Information

 

Hello to everyone!
I have a question for you. What is a remission? I have stiffness in the morning and pain sometimes but in the afternoon I feel like I have never had RA in my life. I still have fingers tender a little and it"s about it. So what is the definition of remission: no pain, a little pain? I do know when RA IS AT ITS WORSE, I know how it can be but I would like to determine if I need to go on more serious drugs or not. Don't tell me to ask my RD, they don't know much (5 years I am going to different ones and hear different answers! one thing is the same-they want you on MTX REGARDLESS. Thank you.Good question, one I have been wanting to ask for a while.  I guess everyone is different. Will be interesting to hear different views.Remission for me is being able to conduct myself in a normal way without discomfort.
I would say that I am in medical remission as I only feel the Ra in a very slight way.

I have tried to back off the drugs a teeny bit but the RA let's me know that it is still around so back up to full dose.

I still have issues with my nervous system but if I keep as stress free as possible, then I can manage.

Clinical remission is:  no pain/stiffness, no inflammation or swelling on xray and MRI, normal labs.  Many RDs will start reducing your meds after 6 months of clinical remission, some RDs after 12 months, and others don't reduce meds at all.     This has been discussed many times before.  There are several websites that discuss the new protocol for clinical remission.  I think it was discussed here about a month ago.  Do a search and you should be able to find the info.  And yes, I'm going to tell you to talk to your RD - medication questions should be answered by your RD.  Only an examination, xrays/MRI/labs can tell you if you're in clinical remission.  Lindy

It's subjective, your doctor decides when you are in remission, and then as Lin mentions above, can either reduce, maintain, or increase your meds.  You mean you can be truly completely pain free and no stiffness ever? [QUOTE=LinB]

Clinical remission is:  no pain/stiffness, no inflammation or swelling on xray and MRI, normal labs.  Many RDs will start reducing your meds after 6 months of clinical remission, some RDs after 12 months, and others don't reduce meds at all.     This has been discussed many times before.  There are several websites that discuss the new protocol for clinical remission.  I think it was discussed here about a month ago.  Do a search and you should be able to find the info.  And yes, I'm going to tell you to talk to your RD - medication questions should be answered by your RD.  Only an examination, xrays/MRI/labs can tell you if you're in clinical remission.  Lindy

[/QUOTE] You may have pain from damage, as I have.  The number one sign of clinical remission is no signs of inflammation, swelling, or fluid in the synovial areas on xray and MRI.  Damage can cause some pain and stiffness but is unlikely to cause inflamm. and fluid.   I have some swelling still in my fingers but I also have psoriatic arthritis and it's not in remission, just RA.  Because my pain is bearable I have not asked to increase meds or make changes...in fact I am still trying to taper the prednisone. Hi WTBF, You and your RD have one goal - for you to achieve clinical remission.  Without clinical remission damage will continue.  Your RD should be doing labs every 2-3 months and adjusting your medications based on labs and physical examination.  If you still have active disease based on labs and P.E. then your meds should be adjusted or changed, specifically if you have pain.  If the pain is from damage, labs are normal, xray shows no inflammation or fluid then you don't need a change in your meds.  My labs are done every 2 months and my levels are normal to near normal so far. I'm going tomorrow for new ones. I had only a baseline hand xray which showed no damage at onset. I'm only 8 months into this crap. When he asks me about pain levels I say 1 or 2. wanttobeRAfree2008-08-14 19:24:56Thank you. In my understanding I have never been in complete remission. I had been going to RDs every 3 months for the first 3 out of 5 years. I felt great most of the time. They did lab work and showed no inflammation in most tests and always positive RF. If I didn't complain and examination showed no swelling then they left me on plaquenil without suggesting to reduce my dosage (I may be on minimum- 200 mg- 1 pill a day?). I asked RD if it was OK to go off drugs he said that nobody with RA could have normal life without drugs. When I complained he wanted me to start taking MXT. I have never had a lot of swelling and last X-Rays showed no damage in my hands, what surprised my new doctor(this is where the majority of my pain is). The thing is that every day is different and every week is different. Last week I was stiff, this week I am not. Overall RD wants to see me on MXT, but I don't want to take it. I take sulfasalazin 1/2 of recommended dosage. Watch out for a doctor who is involved in research, one of mine RDs is and he pushed drugs on me like crazy even when I felt OK. He also ordered more than necessary labs what cost me a fortune. He was trying to do some of his research at patients expense. He wanted me to quit drinking wine so he could prescribe me more drugs and it wouldn't interfere with his results!I made him angry! My new doctor also said that I am a good candidate for research but I need to be on heavy duty drugs, but she also said since I feel good there is no need for it. I think they can't figure out why I feel good with no damage in my bones while my labs show pretty perfect picture of classical RA with bad prognosis and I am still on mild drugs. Try to figure! I think it is diet and exercise! Last week I went to Brazilien (SP?) Steak House and I had more stiffness in the morning all week. This week I am on nuts (pine nuts-non-inflammatory by the way!), red wine, berries,veggies, sea food and I am back to normal skipping my pills again and feeling great. Sorry for such a long message. Stretching and water exercises do wonder too! But I don;t think I am in "clinical remission" because I do have 1-2 days every month when it hurts (not much but it is there!):)Usually when I am stressed or eat something what My body doesn't like (meat, dairy, fried junk).pepper282008-08-15 11:18:35Pepper,  You have no damage, minimal pain, but you just stated that your RA factor is positive.  If you're RA factor is positive you're not in clinical remission and that's the reason your RD wants you to start MXT.  It doesn't appear that you're compliant with your meds.  You stated that you were skipping your pills because you felt great.  This may be the reason that your rheumatoid factor is positive.  If you took your meds as prescribed you might achieve clinical remission and not have to move on to MXT.  You're reluctant to move on to MXT because RA so far isn't too much of a problem for you and you're reluctant to give up drinking wine (in other posts that you've made)  but that could change overnight.  Don't think your RD is trying to force medication on you because they want to do research on you.  MXT has been used for years and has been researched for years, so you taking it isn't going to add anymore information to the research studies.  They don't enroll you in research studies unless you consent, fill out a multitude of forms and follow their protocol.

While pain is a devestating symptom of RA the real enemy is the inflammation as that is what is causing the damage and pain.  too often we believe that if the pain is under control the disease is as well.  Or If the pain isn't so bad then I don't need to be more aggressive in treating it.  If pain is occurring something is going on could be damage could be inflammation but it should never be accepted just because it is better than it used to be.  Absence of pain is good but just because there is no pain does not mean that there is not inflammtion.

Gee LinB, you do explain everything so well. I have been asking both my RD and GP is the pain in my wrists normal or is there still damage going on as my wrists to me, are getting worse.  Just the other day I dislocated my left wrist and having trouble now moving my little finger up.  When you say about normal lab report, do you mean the CRP & ESR, & should I get periodally xrays done. thanks again for being so helpful.I wish I could remember...I have only a vague recollection of a time when this RA wasn't kicking my butt on a daily basis. RAnnie, RA factor, ESR, CRP are the labs that are reviewed.  I have xrays every year on my hands and feet because for 5 years I was able to work fulltime, have my own business, and I ignored the pain or ingested 12 Ibuprofen a day.  Even though the pain was minimal most of the time I did have inflammation and I have erosions and other damage in all of my digits, wrists, knees, and ankles. 

Thanks LinB, I am one of the lucky ones, I only have severe pain in my wrists, but do tend to ignore it and take pain killers all day. I went to a massage therapist today and she did say I had swelling in my wrist so I will call my RD on Monday and see what he has to say. I ask this question to myself over and over. I had a huge flare in march and in april I began taking MTX, 10 mg, I was able to quickly give up prednisone. After 5 months of MTX, I feel completely healthy, even if i am under great strain taking care of my 6 months old daughter. Yesterday I found out my blood results: my CRP is back to normal, meaning less than 6 (in the beginning it had reached 48). unfortunately my family doctor did't prescribe the RF too, I regret not having done it on my own expense but I will do it as soon as possible. I felt so good so I did't go to my rheumy for quite a while, I hope she'll be optimistic about my prognosis. Yet I can feel sometimes the threat of just a tiny tiny stifness in my feet, but I am soo very tired every day so I think that if I could rest as it should, at day and at night, I would really not feel it at all.

[QUOTE=miruna]Has anyone felt the same, and then reduced the MTX? What happened next? Thanks, Stephen! I somehow knew it :( ! LinB, thank you. I know that am not a good patient. Now when I look back I remember there were times I didn't have symptoms at all. I was taking prednison, lodene and plaquenil. This is what RD prescribed me at first.
My new RD PUT ME ON SULFASALAZIN in addition to plaqenil, and she said it was the same as MXT. SulfasALAZIN is popular in Europe because you can take it and still enjoy wine. 2 pills (500mg) twice a day. I have been taking one pill twice a day and not on regular basis. I hear what you are saying and agree, and I notice that I have more and more days when my mornings are getting painful. I will do a full dosage and see what happens. Anyway, yesterday I asked a friend of mine who is GP about remission. He said my condition is described in medical terms as "controlled" and not in remission(I did show him my test results before).
I was so scared in the beginning (after onset)and was compliant with everything, but over five years I learned to ignore little pain, stiffness in the morning and don't think about RA all the time. As a result I started experimenting with reducing my prescribed dosage. I heard that bone destruction is always preceded by swelling as general rule and therefore I am only concerned when I have some swelling (I never had much of it-just some)Nevertheless, I am sure the damage is being done. I was surprised myself about my X-rays and thought it was a mistake (not my X-rays?). First, I will do what my RD told me to do and if I DON'T GO INTO REMISSION THEN I guess I will give in to MXT. By the way, a question for people who are in true clinical remission (if they are still on this website): is your RF positive or it turned into negative? Thanks again for your advice. Hi Pepper, my RF is negative.  When I was first diagnosed (11 years ago)  my RF was 972.  In April my labs were completely normal, including my RF.  One of the criteria for clinical remission is RF, CRP, ESR to be normal values.  I'm also on sulfasalazin along with MXT and Humria.  We're trying to get the psoriatic arthritis (PsA) under control. With psoriatic arthritis RF, CRP, ESR can be normal but you can still have active PsA.  Even though the same meds are used for PsA as RA, PsA is an all together different type of arthritis.    LinB2008-08-16 10:43:42
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