Psoriatic arthritis patients who stop their medication because their disease is in remission are likely to experience a rapid recurrence, according to a small study published online recently in the journal BMJ.

Psoriatic arthritis (PsA) – a form of inflammatory arthritis related to the skin condition psoriasis that affects both skin and joints – is often treated with conventional disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, and biologic drugs, primarily tumor necrosis factor (TNF) inhibitors such as etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade) and golimumab (Simponi). These drugs help keep the disease under control. In some cases, they can even lead to a disappearance of symptoms, prompting patients to wonder if they still need their medication.

The new study suggests they do.

For the study, researchers at the University of Erlangen-Nuremberg in Germany looked at 26 people with PsA whose disease was in remission (with no musculoskeletal complaints and minimal or no skin symptoms) for at least six months and who were being treated with either a conventional DMARD or a TNF inhibitor. The patients were taken off their medication and monitored for six months. If a doctor confirmed a disease flare, the medication was restarted right away.

Twenty of the 26 patients developed doctor-confirmed symptoms again within the study period. On average, symptoms recurred within 74.5 days (about 3 ½ months). The study found no difference in recurrence rates between patients who had been taking methotrexate and those who had been taking a TNF inhibitor. Women were more likely than men to stay in remission, and people who had had the disease for a longer time and those who had more severe skin symptoms were less likely to stay in remission.

Lead study author Georg Schett, MD, professor of medicine, says he was “very much” surprised at the high rate of recurrence. The results mean “that we rarely cure PsA with current treatment but rather, effectively suppress inflammation and hence signs and symptoms,” says Dr. Schett.

Soumya Reddy, MD, was surprised mainly by the speed of recurrence. “It happened pretty rapidly,” says Dr. Reddy, assistant professor of medicine at New York University Langone Medical Center and co-director of its Psoriasis and Psoriatic Arthritis Center. According to conventional wisdom, patients are likely to relapse “somewhere within a few months to 18 months” after going off medication.