Achieving arthritis remission may not actually be as daunting as the death-defying tasks that brought super-spy Ethan Hunt out of retirement in Mission Impossible III. In fact, it may be well within the grasp of nearly half of the 2.1 million Americans with RA. The earlier one begins rheumatoid arthritis treatment, the better one’s odds are.
“If you have fewer than 15 minutes of morning stiffness and no tender or swollen joints for at least three months, that’s definitely remission,” says Salahuddin Kazi, the chief of rheumatology at the Dallas VA Medical Center in Texas. “From a functional perspective, you can do all that you want to do. You have no limitations and no pain.”
Sound too good to be true? It’s not, says Désirée van der Heijde, MD, a professor of rheumatology at the University Hospital Maastricht in the Netherlands. She says that with today’s newer rheumatoid arthritis treatments, as well as with more aggressive use of older treatments such as methotrexate, nearly half of people with RA can – and should – achieve remission.
In the Trial of Etanercept and Methotrexate with Radiographic Patient Outcomes (TEMPO), a two-year study of 682 people with RA from 92 treatment centers in Europe and Australia, more than three quarters of people treated with the biologic drug etanercept (Enbrel) plus the disease-modifying antirheumatic drug (DMARD) methotrexate experienced no progression of joint damage at three years. More than 40 percent achieved clinical arthritis remission.
“Treating early before damage occurs gives you a higher probability of remission,” says Dr. van der Heijde, adding, “TEMPO showed a high percentage of patients in remission, even in those with relatively longstanding disease.” Exactly how close you can get to arthritis remission depends on how aggressively you are treated early on, agrees Dr. Kazi.
“If you get treated within two years of the onset of RA symptoms, you have more than a 50 percent chance of achieving remission.” Chances are even better if you have mild disease activity and test negative for blood markers such as rheumatoid factor, he says. “If you get treated within five years of onset, TEMPO shows you still have a good chance of achieving remission.”
“At least 60 percent of RA patients should have low or moderate disease activity with today’s treatments, including the subset of biologics called TNF inhibitors – adalimumab (Humira), Enbrel, infliximab (Remicade) – and the newer biologic agents, such as abatacept (Orencia) or rituximab (Rituxan),” he says.
Don’t take no for an answer, Dr. Kazi says. “Develop a partnership with your doctor where you can say, ‘I still have some disease activity; can I have a higher dose of medication or try something different?’”
