While lots of studies have been conducted on rheumatoid arthritis (RA), there is still no complete cure and its exact cause remains unknown. However, by making some lifestyle changes and taking some medications, you can lead a fairly normal life. One question that continues to be debated is whether or not a person with RA who feels a lot better is in remission. Since 2011, rheumatologists from America and Europe have been in agreement that RA remission needs not mean the elimination of the disease. So what can you do to put your condition into remission?
What Is Rheumatoid Arthritis Remission?
Most researchers and doctors define remission as significant reduction in symptoms and signs of RA. This does not mean that the RA is cured. There are two modern criteria to define RA remission.
Definition 1
Under definition 1, RA clinical remission is realized when the following conditions are met:
- You have a maximum of one tender joint.
- You rate your arthritic pain at 1 or below on a 0 – 10 scale
- Not more than one of your joints is swollen
- A C-reactive protein (CRP) test for inflammation in blood shows no or minimal C-reactive protein.
Definition 2
For definition 2, the doctor assesses the criteria in definition 1. The doctor then incorporates his own conclusion on your RA condition. A patient is considered to be in RA remission if the score is not more than 3.3 with 100 being the highest score.
Under the two new definitions, patients achieve remission when they experience minimum or zero RA symptoms. Some doctors also consider morning joint stiffness, and the length of stiffness. Below 15 mins is considered good.
How to Tell If the Patient Is in Remission
To find out the extent of improvement in order to determine when rheumatoid arthritis remission has been realized, doctors may order certain tests and observe various factors.
- Physical Examination
The doctor carries out a physical examination of a patient's joints, taking swelling, tenderness, loss of mobility into consideration, besides an overall assessment of the RA patient.
- Self-Reported Symptoms
Information by the patient about morning stiffness, pain and other symptoms can be valuable to the doctor. Your doctor may need you to rate your pain and overall health on a scale of 1 to 10.
- Blood Tests
A doctor may order blood tests to assess a patients' RA. The tests include rheumatoid factor (RF) test to measure levels of an antibody which is usually in high levels in many RA patients; erythrocyte sedimentation rate (ESR) test to measure the general levels of inflammatory activities in the body; and the C-reactive protein (CRP) test to detect and monitor inflammation.
- Imaging Tests
These are X-rays and MRI (magnetic resonance imaging) scans that show the extent of damage caused by RA on bone, cartilage and tissues within and around the joint.
- Questionnaires
Several questionnaires have been developed which assist doctors to find out how RA affects a patient's life quality. The most common questionnaires are the Short-Form Healthy Survey (SF-36) and the Health Assessment Questionnaire (HAQ).
How to Put Rheumatoid Arthritis into Remission
Most rheumatologists advise that early treatment of rheumatoid arthritis helps to achieve rheumatoid arthritis remission. In addition to treatment, you need to practice the following:
1. Pay Attention to Your Diet
Diet is important for people with RA as it can reverse the symptoms. Avoid or limit the intake of inflammatory foods such as fatty meat, whole milk products, starches, refined flours, added sugar, processed foods, hydrogenated fats and oils. Eat as many anti-inflammatory foods as possible, including avocado, olive oil, salmon, nuts, whole grains, antioxidant-rich fruits and herbs. Curcumin, a natural pain reliever in turmeric is also said to have powerful anti-inflammatory properties.
2. Control Your Weight
Excess weight in people with RA adds excess stress on the affected joints and weight-bearing joints such as the knees. To shed excess weight, exercise regularly. Low-impact aerobic exercises and yoga are some of the recommended routines to keep your weight in check.
3. Ensure Vitamin D Intake
Vitamin D is essential for healthy maintenance of bones, cartilage, muscle and joints. If you have RA and you don't get enough vitamin D, it is difficult to achieve remission. You get vitamin D from the sun and dietary sources such as egg yolk, milk, and yogurt.
4. Take Medications
Treatment with recently developed medications known as disease-modifying anti-rheumatic drugs (DMARDs) have been found to slow down the progress of RA as well as protect joints and tissues from permanent damage. For maximum benefits, doctors advise that treatment commences as early as possible. Commonly used DMARDs include sulfasalazine (Azulfidine), leflunomide (Arava), methotrexate (Trexall, Otrexup, Rasuvo) and hydroxychloroquine (Plaquenil).
Is It Possible to Experience Relapse After Remission?
Having achieved remission, many people with RA suffer a relapse. A 2012 study involving 394 RA subjects followed for two years found that 50 percent of them suffered a relapse after achieving remission. Here are some reasons for the occurrence of relapse.
1. Stopping Medication Can Trigger Relapse
Once some patients have achieved rheumatoid arthritis remission, they may wrongly believe that they have been cured and no longer take medication. In this condition, relapse is generally a result of medical noncompliance as patients may take their medication irregularly or stop all together, thereby exposing themselves to RA flares. Additionally, a relapse may occur if a doctor reduces or orders discontinuation of RA medication as part of preparation for another medical procedure such as surgery.
2. Biologics Can Stop Working
Relapse from remission can occur even when a person with RA takes medicine as prescribed. A study published in 2012 found that although biologic medicines such as the tumor-necrosis factor (TNF), inhibitors infliximab (Remicade), and adalimumab (Humira) have helped many RA patients achieve remission, their effectiveness may fall in people who develop antibodies against them. In normal circumstances, the body produces antibodies to fight off germs and other harmful intruders. But antibodies are sometimes produced in a patient's body to block the activities of biologic medications.
How to Prevent Relapse
Besides taking medication as directed by your doctor, you can prevent a relapse from rheumatoid arthritis remission by making lifestyle changes, including the following:
1. Exercise
Regular, low impact exercises such as swimming, yoga, and tai chi can keep you safe from RA relapse. Avoid high-impact exercises such as basketball and soccer because they could trigger a flare.
2. Get Immunized
Because RA and RA medications depress the immune system, it is important to get immunized against infections to which you may be prone to.
3. Relax
Stress, whether physical or psychological, is known to trigger RA flares. So people with RA need to avoid stress and learn to relax themselves. Try meditation and some breathing exercises.