What is Remission? Although there is no cure for rheumatoid arthritis, people can feel ‘cured’ of the disease when their symptoms are reduced or have disappeared. If you do happen to feel like this, then you may be experiencing what health professionals term “clinical remission”. This means that your treatment is working very well. Remission means that you are not experiencing any of the typical signs and symptoms of inflammation, such as pain in the joints and stiffness. While remission may be only temporary, it can continue for some time. In this article we provide answers to common questions you may have on remission and on how you can devise your personal ‘treatment goals’. How can you tell that you are in remission? Rheumatoid arthritis is an unpredictable disease, and most people will experience both disease ‘flare-ups’ (called relapses) and periods where you are symptom-free (remission). Sometimes the remission is only partial, with relief from some but not all the symptoms of rheumatoid arthritis. Even when you are in remission and do feel better, it is important to continue with medical follow-up so that your doctor can assess and confirm whether you are in full or partial remission and what treatment regime you should be following. Any treatments should be continued even if you do feel well, until you receive medical advice about reducing your medication. Your doctor will also ask a number of questions to determine whether you are in remission or not. Blood tests may be recommended and/or comparing a new x-ray to older ones to see if joint damage has continued. The following criteria from the American College of Rheumatology (ACR) are often used as a guide for doctors in Ireland as to whether a patient is in remission: Morning stiffness for less than 15 minutes No fatigue No joint pain No tenderness of pain on motion No soft tissue swelling Testing positive for the ESR blood test which measures inflammation If you have five or more of the following criteria for more than two months, you may be in remission. The longer the disease remains in remission, the less likely it is to become active again. Do you feel you are doing as well as you should be? Health professionals working in rheumatology use remission as the optimum ‘treatment goal’; they also have their own standards for determining remission and for ‘scoring’ or assessing joint damage. However, still the most important issue really is how you, yourself feel. Though you might not be able to describe the amount of joint damage you have, you will know how you are feeling and be able to describe your symptoms. You may hear them referring to Disease Activity Scores, known as DAS scores. These were devised to assess rheumatoid arthritis. Doctors have a complicated formula for working this score out, but put simply, they look at specific different aspects of your RA to assess disease activity. DAS scores are measured twice within one month. However, still the most important issue is how you work together with your doctor to set your own personal treatment goals. With rheumatoid arthritis, it is unrealistic to aim to cure the disease. However, it is strongly advisable to define your ‘treatment goals’, which are essentially any positive outcomes that you and your doctor need to aim for as a result of your treatment. These goals are an important way of monitoring whether your treatment plan is working. Below are some of the most common treatment goals: Taking control of the underlying disease itself in addition to the symptoms Preventing further joint damage Relieving pain Maintaining or improving physical function and quality of life You may be able to achieve remission on the right treatment plan. To help this happen though, it is important that you visit your doctor regularly, especially if your symptoms get worse during the course of your treatment. Updating your doctor on your progress with your medication is vital to helping you achieve the goals you have set. Your current medication may not be providing the best relief for you. And if you are not getting pain relief from the medication it is probably not treating the underlying disease either. The most effective types of medication will control both the disease and symptoms. Only your doctor will be able to decide if it is the right time to switch to a different medication. Your symptom record is still the most critical information upon which to make decisions about treatment. Remember not every medication works for everyone; both treatment goals and treatment plans are tailored for each person. Below are some tips on how you can help your doctor with your treatment plan: When you visit your doctor write out any questions you have in advance, so you won’t forget them. Make sure you tell your doctor about the symptoms that bother you most. Try to use descriptive words to describe your pain like aching, burning, etc as it can help the doctor assess the level of pain you are in. Keep a written record of your symptoms. Write down your symptoms in a special diary and draw up your own scale from 1 to 10 based on how you feel that day. Even if you are in remission, keep a ‘Wellness Diary’, describing how you feel Write down other factors that might influence your symptoms for example stress, diet, weather etc.