“In this study, they’re seeing that about 75 percent recurred within the six months and most of them within the first two to three months. I think this reflects clinically what we see; usually the disease does come back within several months to some degree,” she says.

Even when symptoms stay at bay for a longer period, symptoms can still return, says Dr. Reddy. “We’ve all seen patients who’ve had no disease for five years and then it recurs after five years.”

The researchers say it appears that though the disease may quiet down during remission, it doesn’t cease to exist. “A very interesting and stunning finding was the fact that the distribution of joint disease at the time of flare followed its original distribution, suggesting a kind of tissue memory,” Dr. Schett notes.

The study authors hypothesize that starting treatment for PsA as early as possible could, in theory, make the disease more curable and lasting remission more likely. “The observation that longer disease duration and synovial hypertrophy [thickening of the joint lining, a sign of chronic inflammation in the joints] by ultrasound are more often associated with the recurrence of PsA suggests that joint damage in conjunction with inflammation may prime these joints for disease and enhance their susceptibility to become affected again. Such concept would further strengthen the importance of early intervention in PsA,” they write.

The study looked at patients who had had the disease for a long time. “These are the types of patients that we see – patients who have had disease for many years, and they’re well controlled on either methotrexate, a combination of methotrexate and a biologic, or just a biologic,” says Dr. Reddy. “If you looked at patients who had shorter disease duration, would the outcome be different? Or if you had patients who had less severe disease? That might be something to look at.”

The results are not relevant to rheumatoid arthritis, notes Dr. Schett, since that disease “is fundamentally different” from PsA, but they could potentially have implications for spondyloarthritis – a type of arthritis that usually affects the spine – “as there are shared pathophysiological concepts.”

Although some PsA patients may be frustrated by the need to stay on medication, remission is far better than no remission. “Sometimes after four years, you forget how you felt before, how affected your joints and your skin were, prior to being on the medications,” says Dr. Reddy. “The fact that you see the patient assessment scores worsening so rapidly [after stopping medication] also proves to the patients when they stop the medication that the medication really was doing something dramatic for them.”