Q: With taking injections of methotrexate and Humira, along with naproxen and folic acid, I have had very little joint pain, swelling or morning stiffness for at least three months. Does that mean my RA and psoriatic arthritis are in remission, and can I stop medication, or at least the injections temporarily?  

A: You may well be in remission, but you should not stop medication by injection. The combination of an immunosuppressant (methotrexate) and a biologic agent (Humira) can result in a near-complete cessation of symptoms in a high percentage of people. Your excellent response with very little pain in the joints and no morning stiffness or swelling for the past three months could be classified as a “clinical” remission.

But without the injections, the diseases most likely will come back within four to eight weeks as strongly as before you started taking those medications. Most important, if the disease becomes more active, you will have an increased risk of damage to the joints. I certainly understand your desire to stop medication or use less, but you must balance it with the need to keep the RA and psoriatic arthritis under control, in order to halt the progression of your diseases.

Once a clinical remission is achieved, we attempt to lower the amount of medications while maintaining the remission. I recommend you talk to your rheumatologist about first reducing your dose of naproxen, which is an NSAID. People in clinical remission usually can discontinue their NSAID; because it does not halt the progression of RA or psoriatic arthritis, stopping it does not increase the risk for disease-related damage. Once the NSAID is discontinued, sometimes the methotrexate dose can be lowered next, but this is an individual decision to be made with your rheumatologist. Rarely can a person stop a biologic agent and maintain a clinical remission. 

Paul Howard, MD, Rheumatologist