The New Definition of RA Remission

Rheumatoid arthritis (RA) is a chronic autoimmune condition that currently doesn’t have a cure, but you can go through periods of lesser or even no symptoms. This is called remission.

Remission does not mean you can stop taking medication to treat your RA. Usually, medications play an important role in achieving and maintaining remission. Some providers will change your medication dosing or recommend that you take a short break, aka a drug holiday, from your medications if and when remission is achieved.

Early treatment shows the best likelihood for RA remission, but there is no set timeline. Remission doesn’t mean that you no longer have RA, either. Relapses are possible after months, years, or even decades. It’s complicated.

Defining RA remission is even more complicated. Symptom reporting can be very subjective, and there is no concrete test, like a blood test or imaging, that proves remission, either.

The American College of Rheumatology (ACR) and the European Alliance of Associations for Rheumatology (EULAR) recently updated their definition of RA remission.

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The old definitions of remission

Since 2011, ACR and EULAR have defined remission in two ways.

The first is called the simplified disease activity index (SDAI). It asks you and your provider to rate your overall health and number your tender joint count, swollen joint count, and C-reactive protein (CRP) levels to give you a numerical score. If you have an SDAI of less than 3.3, you’re considered to be in remission.

The second is called the Boolean method. To have achieved remission, your tender joint count, swollen joint count, CRP levels, and patient assessment of global disease activity (PtGA) each cannot exceed a score of one.

The new definition of remission

The 2011 guidelines were interim recommendations that hadn’t yet been validated by large data sets. New data has allowed the ACR and EULAR to change those guidelines. The main change to the remission definition is that you may score slightly higher on the PtGA and still be considered in remission.

The PtGA is used to evaluate someone’s perspective on aspects of their RA and overall health. The PtGA is assessed by asking one question with a 0 to 10 or 0 to 100 rating as a response. The question may vary by provider but is usually something along the lines of “How is your health overall?” or “How active is your arthritis?”

Based on the previous definition of remission, you had to rate yourself at a one or less to be considered in remission. The new validated guidelines allow you to rate yourself at a two, and you could still be in remission.

This PtGA scoring change allows a little more flexibility when aiming for remission. This is important because other factors can influence your overall health with RA, including depression, anxiety, inability to participate, fibromyalgia, advanced age, and degenerative arthritis. It can be difficult to report symptoms caused by RA alone.

The takeaway

This change might seem insignificant, but many more people with RA can now achieve clinical remission. With this new criteria, the percentage of people in remission increased from 14.8% to 20.6% in people with early RA and from 4.2% to 6% in those with more established disease.

With the old system, some people in clinical remission could miss the cut-off by one point because of mitigating factors. For example, people with constant pain from irreversible joint damage rate their PtGA high, despite all other measures being low scoring. The new guidelines account for these compounding factors.

The new definition of remission can help people receive better treatment. You and your provider can create a more accurate care plan when all aspects of your RA are considered, including what was previously barring you from clinical remission.