Got RA? Remission may be reachable.

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Remission Impossible?

Arthritis Today, NOVEMBER-DECEMBER 2006

by Lynn Mann

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.