INFO - Arthritis Today: Remission Impossible?

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Your Health: Medwatch

Arthritis Today, NOVEMBER-DECEMBER 2006

by Lynn Mann

Remission Impossible?

Got RA? Remission may be reachable.

Putting RA into remission may not actually be as daunting as the

death-defying tasks that brought super-spy Ethan Hunt out of retirement in

Mission Impossible III. In fact, it may be well within the grasp of nearly

half of the 2.1 million Americans with RA.

" If you have fewer than 15 minutes of morning stiffness and no tender or

swollen joints for at least three months, that's definitely remission, " says

Salahuddin Kazi, the chief of rheumatology at the Dallas VA Medical Center

in Texas. " From a functional perspective, you can do all that you want to

do. You have no limitations and no pain. "

Sound too good to be true? It's not, says Désirée van der Heijde, MD, a

professor of rheumatology at the University Hospital Maastricht in the

Netherlands. She says with today's newer treatments, as well as with more

aggressive use of older treatments, like methotrexate, nearly half of people

with RA can - and should - achieve remission.

In the Trial of Etanercept and Methotrexate with Radiographic Patient

Outcomes (TEMPO), a two-year study of 682 people with RA from 92 treatment

centers in Europe and Australia, more than three quarters of people treated

with the biologic drug etanercept (Enbrel) plus the disease-modifying

antirheumatic drug (DMARD) methotrexate experienced no progression of joint

damage at three years. More than 40 percent achieved clinical remission.

" Treating early before damage occurs gives you a higher probability of

remission, " says Dr. van der Heijde. She adds that " TEMPO showed a high

percentage of patients in remission, even in those with relatively

longstanding disease. "

Exactly how close you can get to remission depends on how aggressively you

are treated early on, agrees Dr. Kazi. " If you get treated within two years

of the onset of RA symptoms, you have more than a 50-percent chance of

achieving remission, " he says. Chances are even better if you have early,

mild disease and test negative for blood markers such as rheumatoid factor,

he says. " If you get treated within five years of onset, TEMPO shows you

still have a good chance of achieving remission. "

" At least 60 percent of RA patients should have low or moderate disease

activity with today's treatments, including the subset of biologics called

TNF inhibitors - adalimumab (Humira), Enbrel, infliximab (Remicade) - and

the newer biologic agents, such as abatacept (Orencia) or rituximab

(Rituxan), " he says.

Don't take no for an answer, Dr. Kazi says. " Develop a partnership with your

doctor where you can say, 'I still have some disease activity; can I have a

higher dose of medication or try something different?' " he suggests.

http://www.arthritis.org/resources/arthritistoday/2006_archives/2006_11_12/Remis\

sion_Impossible.asp

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