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Rheumatoid arthritis (RA) has traditionally been thought of as a lifelong disease requiring medication to control symptoms, similar to hypertension or diabetes. However, with the remarkable advances in treatment for RA seen in recent decades, many experts are suggesting that for some patients, it may be possible to cut back on treatment -- or even stop it altogether. Factors that must be considered include the potential for overtreatment or undertreatment, the burden of side effects, and cost concerns.

Sustained Remission

But before decreases in treatment can be considered, your treatment goal needs to be sustained remission, so that you will be unlikely to experience disease flares and potential damage to your afflicted joints. This is typically achieved through treatment strategies referred to as "tight control" and "treat to target," meaning frequent assessment of symptoms and prompt adjustment of treatment if therapeutic goals are not being met.

Remission today is defined in various ways, but generally includes a minimal number of swollen and tender joints, your overall assessment of disease and well-being, and the presence or absence of markers of inflammation. Some experts also advocate the use of ultrasound to detect any residual disease activity in the joints. Sustained remission typically is defined as uninterrupted symptom-free disease for at least 6 months.

Cutting Back on Treatment

Many studies have looked at ways of tapering treatment, such as by cutting back on drug dosages or increasing the intervals between infusions or injections, usually slowly and gradually. In addition, many studies have focused specifically on withdrawing biologic therapy while maintaining baseline methotrexate. Success rates with treatment withdrawal thus far have been fairly low, but many have included patients who were not clearly in remission. Patients considered to have "low disease activity" rather than true remission today are not advised to attempt tapering their treatment.

Who Can Benefit?

Researchers have also sought to identify factors that could help predict which patients with RA are most likely to do well with decreased treatment. They have suggested that success is more likely among patients with early disease, and those whose disease activity scores are very low. Patients who do not have RA disease markers such as rheumatoid factor, also known as RF, or anti-citrullinated protein antibodies, or ACPA, tend to fare better than those who have these markers, as do patients who have normal levels of certain T-cell subsets.

You and Your Rheumatologist: A Crucial Partnership

Any treatment adjustments must be made in a process of shared decision-making between you and your rheumatologist, with your experiences and values being important components of choices in treatment. Some patients may be more willing to take chances with slowing or stopping treatment, given the potential risk for disease flare, while others may prefer to remain on a stable regimen with acceptable risks of side effects.

But any time you undertake changes to your treatment plan, be sure to discuss it with your rheumatologist, and watch closely and report quickly any recurrence of symptoms or other changes to your health.

Your future with RA looks bright, with many new treatments and treatment approaches available, and relies on a strong partnership between you and your rheumatologist. Be well!

Read previous installments in this series:

For Your Patients: What Is Rheumatoid Arthritis?

For Your Patients: How Is Rheumatoid Arthritis Diagnosed?

For Your Patients: Starting Treatment for Rheumatoid Arthritis

For Your Patients: Beyond the First RA Treatments

For Your Patients: Special Concerns About COVID

For Your Patients: Reproductive Health in RA

For Your Patients: How to Cope With Rheumatoid Arthritis

For Your Patients: Heart Health in Rheumatoid Arthritis

For Your Patients: The Future of Treatment for Rheumatoid Arthritis

"Medical Journeys" is a set of clinical resources reviewed by doctors, meant for physicians and other healthcare professionals as well as the patients they serve. Each episode of this 12-part journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.