This post is part of the Talk Over RA 2025 campaign and is sponsored by AbbVie. All content and opinions are my own and are not intended to promote any specific pharmaceutical products.
If you’re living with rheumatoid arthritis (RA), you know how powerful, even revolutionary, the word “remission” can sound and how it is a relatively new concept. Before the era of modern treatments in the last 30 years, RA patients rarely achieved anything close to remission, and persistent pain and joint deformity were heartbreakingly common. In reality, remission was unattainable for decades.
As someone living with rheumatoid arthritis, my goal has always been to understand remission as deeply as possible, not just through clinical definitions, but through lived experience, scientific evidence and multidisciplinary insight.
When someone with rheumatoid arthritis says they are fighting RA, it means they are fighting for remission. I was diagnosed with rheumatoid arthritis in 2015 and I was scared because I knew all too well the devastating impact this disease can have on someone. My aunt was diagnosed with RA before I was even born and lived with it for over 40 years. I rarely saw her walk a few steps, she was in pain all the time, her hands were deformed, she struggled with obesity and she had many common RA comorbidities like type 2 diabetes and heart disease. She passed away the same week I was diagnosed with RA from those comorbidities.
After five years of contributing to the Talk Over RA campaign, I’ve had the privilege of interviewing eight rheumatologists from around the world, including experts from the UK, US, Canada, Brazil, India, and Spain, to explore what remission in rheumatoid arthritis truly means. I’ve also spoken with a nurse practitioner and a registered dietitian who both live with RA, as well as two occupational therapists, a physiotherapist, and a psychologist.
Through these conversations, I’ve discovered that remission isn’t as simple as it sounds. Yes, it brings hope and relief, but it comes with its own complexities, questions, and ongoing decisions. If you are feeling confused and overwhelmed, this article is to help you navigate this journey towards understanding, targeting and achieving remission.
Talk Over RA – A Global Perspective: Spain
On this special episode of ‘Rheumer has It’, hosts Eileen and Cheryl are joined by renowned rheumatologist Dr. Loreto Carmona from Spain. The discussion centers around the concept of remission in rheumatoid arthritis (RA), highlighting the differences between medical and patient perspectives on what constitutes remission. Dr. Carmona emphasizes the importance of communication between patients and doctors, the role of medications and lifestyle factors, and the myths surrounding RA remission
If you live with rheumatoid arthritis, you might hear your doctor talk about “remission.” That means your disease is under control, but how do we measure that?
In recent years, there have been new disease-modifying options for people living with rheumatoid arthritis. For some, this can even mean working toward remission. Unfortunately, my aunt was diagnosed quite a few years before the development of these medications. Today, there are more options to help manage arthritis and support joint health.
This shift also created a challenge: how to define “remission” in a way that’s both practical and meaningful, consistent enough for research, stringent enough to ensure safety, but not so strict that it excluded most patients.
Development of Standardized Remission Criteria: ACR & EULAR
To unify both research and patient care, the American College of Rheumatology (ACR) and European Alliance of Associations for Rheumatology (EULAR) have continued to refine the official definitions of remission. Their latest major update was in 2011, with further refinements published in 2022 to update their guidelines to make remission more realistic and meaningful for patients.: American College of Rheumatology/EULAR remission criteria for rheumatoid arthritis: 2022 revision
Recent Updates Include:
The definition of remission in rheumatoid arthritis has evolved to better reflect real-world experiences while still aiming for the best possible outcomes. One key change involves the Patient Global Assessment (PtGA), a 0–10 scale where patients rate how they feel overall. Previously, a score of 1 or less was required to meet remission criteria. Now, the threshold has been raised to 2, making remission more attainable for those with near-complete, but not perfect control of their disease.
This shift matters. It allows more people with RA to be recognized as in remission, even if they still experience some symptoms. Importantly, the updated criteria continue to predict good physical function and reduced joint damage over time. For those living with chronic pain or fatigue, it offers a more balanced and realistic way to measure disease control.
The Global Remission Coalition is an international initiative focused on improving care for people with chronic inflammatory diseases, including rheumatoid arthritis. Their mission is to make remission a central goal in healthcare systems, moving beyond symptom management to long-term disease control. The Global Remission Coalition produces resources to educate and equip advocates to inform patient-centered policies. All resources are free and encouraged to be downloaded and shared.
Learn more about The Global Remission Coalition
How Is Remission Measured in RA?
Remission means your rheumatoid arthritis is mostly or fully under control. There are different ways to measure it and each doctor may measure it slightly differently. Doctors use a mix of physical exams, lab tests, and your own input to decide if you’re in remission. These may include:
1. Boolean-Based Remission
According to this approach, you’re considered in remission if all of these are true:
- 1 or fewer tender joints
- 1 or fewer swollen joints
- Low inflammation in blood (CRP ≤ 1 mg/dL)
- You rate your arthritis as 1 or less on a scale of 0 to 10
2. Index-Based Remission (SDAI and CDAI)
According to this measurement, remission is measured by looking at:
- Tender and swollen joint counts
- Your rating of how you feel
- Your doctor’s rating
- CRP (for SDAI only) Remission means a very low total score (SDAI ≤ 3.3 or CDAI ≤ 2.8)
3. DAS28 Score
DAS stands for “Disease Activity Score.” This older method uses an assessment of tenderness and swelling in 28 joints and lab tests. A score below 2.6 means remission, with 2.6-3.2 indicating low disease activity. This test is less strict than others and not used as often now.
4. Patient Global Assessment
This assessment looks at your answer to one question: :
“Considering all the ways your arthritis has affected you, how do you feel your arthritis is today?” You rate it from 0 (best) to 10 (worst). This helps doctors understand the bigger picture of how you are able to function in your daily life, given your current symptoms and challenges.
What does remission in rheumatoid arthritis actually feel like? For many patients, it’s described as “getting your life back” — being able to enjoy everyday activities, work, movement, and time with loved ones with minimal pain or fatigue. But remission isn’t always perfect. There can still be lingering aches, morning stiffness, or fatigue that creeps in during stressful times. The difference is that these symptoms become manageable, no longer dominating your day.
When I was close to remission in 2020, I noticed profound changes in my daily life:
- Inflammation was under control, and joint damage was no longer progressing
- I needed fewer naps and felt less drained by fatigue
- My energy levels improved noticeably
- I could exercise regularly without triggering flares
- Hobbies and activities that once felt impossible became accessible again
- I slept through the night without being jolted awake by pain
- Tasks like cleaning, cooking, typing, parenting, and even travel became doable
- My mood stabilized, I experienced less irritability, anxiety, and emotional exhaustion.
In 2020, five years into my diagnosis, my rheumatologist told me I was near remission. Looking back, and considering the updated remission guidelines in 2022, especially the change in the Patient Global Assessment threshold, I’m confident I would have been considered in remission at that time. But getting there wasn’t easy. It took persistence, trial and error, and a lot of self-advocacy.
- Exercised Regularly Exercise became one of my most powerful tools. It helped reduce inflammation, improve joint mobility, and lower my risk of other health issues like heart disease and depression. I focused on low impact, joint friendly activities like using the elliptical, swimming, and gentle strength training.
- Focused on Nutrition Over Dieting I learned that while diet won’t cure RA, it can absolutely support your overall health and reduce inflammation. I stopped chasing restrictive diets and instead focused on sustainable, nourishing choices. The Mediterranean diet which is rich in fruits, vegetables, whole grains, healthy fats, and lean proteins is backed by scientific evidence and helped me feel more balanced. I also paid attention to how certain foods affected my energy, digestion, and pain levels. Food can be a big flare trigger for some.
- Kept in Regular Contact with My Rheumatologist Consistent communication with my rheumatologist is always key. I tracked symptoms, asked questions, and made sure my treatment plan reflected how I was actually feeling and not just what lab results showed.
- Gave Medications a Try and Time to Work Finding the right medication takes patience. I learned to give each treatment a fair chance while staying honest about what was and wasn’t working for me. It’s not uncommon to try multiple medications until you find the one that works for you.
- Addressed My Mental Health As someone living with rheumatoid arthritis and depression, I’ve learned that addressing my mental health is just as important as managing physical symptoms because stress, anxiety, and emotional strain can directly impact how I cope, heal, and live day to day
- Built a Healthcare Team RA affects every part of life, so I built a team to support me holistically. This included my rheumatologist, a physiotherapist, occupational therapist, psychologist, and even a dietitian who lives with RA herself. Each professional brought a different lens, helping me manage pain, improve function, cope emotionally, and make informed lifestyle choices.
Explore The Integrative Treatment Guidelines for Rheumatoid Arthritis
The American College of Rheumatology (ACR) integrative treatment guidelines for rheumatoid arthritis provide evidence-based recommendations on non-pharmacologic therapies that can complement medical treatment. These guidelines focus on approaches that support overall well-being, reduce symptoms, and improve quality of life. I was a patient partner on the creation of these guidelines! Discover them here
How Did I Fall Out of Remission?
Unfortunately, remission didn’t last forever for me, only a year or so and the major cause was the covid-19 pandemic. Since then I have learned there are a number of reasons why someone might fall out of remission. For me it was stress, access to medication, and injury/trauma:
Some reasons why remission doesn’t last forever
- Medication Changes or Non-Adherence Stopping, skipping, or adjusting medications without medical guidance can trigger disease activity.
- Stress and Emotional Strain High levels of stress can worsen inflammation and lead to flares.
- Smoking and obesity make remission less likely and flares more frequent.
- Infections or Illness Viral or bacterial infections can disrupt immune balance and provoke RA symptoms.
- Physical Overexertion or Injury Pushing beyond physical limits or sustaining joint injuries can lead to increased pain and inflammation.
- Poor Sleep Quality Inadequate or disrupted sleep can affect immune regulation and pain sensitivity.
- Dietary Triggers or Nutritional Gaps While diet doesn’t cause RA, certain foods may worsen symptoms, and poor nutrition can affect overall health.
- Hormonal Changes Shifts due to pregnancy, menopause, or other hormonal factors can influence disease activity.
- Environmental Factors Cold, damp weather or exposure to pollutants may aggravate symptoms in some individuals.
- Comorbid Conditions Conditions like fibromyalgia, diabetes, or cardiovascular disease may complicate RA management and mimic flares.
- Loss of Access to Care Gaps in treatment due to insurance, financial strain, or provider changes may lead to unmanaged symptoms.
- Disease Progression Even with good management, RA may evolve over time, requiring adjustments in treatment.
What Gets In The Way Of Remission?
One important thing to understand about achieving remission is that it’s not the same for everyone. The severity of rheumatoid arthritis, whether mild, moderate, or severe, can influence how remission is reached. But just as critical are the personal social determinants of health we each carry and must address.
Social determinants of health are the non-medical factors that shape health outcomes. They include the conditions in which we’re born, grow, live, work, and age, and they directly impact access to care, quality of life, and the ability to manage chronic conditions like RA. These factors can either support or hinder someone’s path to remission, treatment adherence, and overall well-being. Recognizing and addressing your social determinants is essential for receiving the care that reflects your real-life circumstances.
Social Determinants That Can Impact Rheumatoid Arthritis Remission
- Limited access to rheumatology care or insurance and coverage gaps
- Financial strain affecting treatment, transportation, or healthy living. Low income patients tend to have poorer health outcomes.
- Low health literacy or difficulty navigating the healthcare system can result in low confidence in self advocacy.
- Lack of social support, social isolation or stigma around invisible illness
- Unsafe environments for exercise or poor housing conditions
- Mental health challenges like depression, anxiety or chronic stress
- Systemic barriers such as racism, ableism, or language gaps
- Depression, anxiety, or chronic stress
- Underrepresentation in research and clinical trials
Medication Tapering: Proceed Carefully
When remission has been stable for at least 6 to 12 months, your doctor might suggest cautiously reducing medication to the minimum effective dose, or in rare cases, pausing medication. Tapering must be gradual, tailored and closely monitored.
Flare Management and Having a Back Up Plan
Having a clear plan if symptoms return (flare) is crucial:
- Maintain regular communication with your care team, know who to contact if symptoms reappear or worsen
- Have a strategy for restarting or increasing medications rapidly if necessary
- Pay attention to early warning signs: fatigue, subtle stiffness, mood changes, trouble with daily tasks
What Remains at Risk During Remission?
Even while feeling “normal,” certain realities persist:
- Flares: Stress, infections, medication changes, or unknown factors may trigger a flare of pain and inflammation.
- Infection risk: Both RA and the medications used to control inflammation may weaken immune defenses. Precautions with vaccinations and infection control are important.
- Comorbidities: Heart disease, osteoporosis, lung issues, and mental health problems are still more common in people with RA than in the general population.
- Old damage: Even when inflammation is quiet, previous joint and organ damage can limit function or cause discomfort.
Important Questions to Ask Your Rheumatologist About Remission
Whether you’re approaching remission, newly in remission, or simply aiming to make the most of your medical appointments, asking thoughtful questions can help you better understand your condition, set realistic goals, and prepare for potential changes. It’s essential to talk with your rheumatologist about how rheumatoid arthritis is affecting your daily life and what you hope to achieve through treatment. Remission in RA involves more than just lab results.
Understanding Remission
- How do you define remission in RA, and what does it mean for someone with my type of disease?
- How will I know when I’ve reached remission, and how often will I need appointments or lab work?
- Can I still experience symptoms like pain or fatigue in remission, and what does that mean?
- Is remission likely to last, or should I expect relapses? Are there strategies to help make remission last longer?
- How will remission or my medications affect my risk of infections, heart disease, lung issues, or osteoporosis?
Medication and Treatment Planning
- After how long in remission can we consider tapering medications, and what does that process look like?
- Am I a candidate for reducing or stopping certain medications? What risks are involved?
- If we reduce my medications, what should I watch out for in terms of flare, and who should I contact if symptoms return?
- What happens if my medications stop working or I experience side effects?
- Can we create a written flare management plan together?
Lifestyle and Preventive Care
- What lifestyle changes could help me get to or stay in remission?
- Should I continue preventive care like vaccines and screenings while in remission? What vaccines should I protect myself with?
- Should I have periodic imaging (e.g., ultrasound or MRI) to check for hidden joint inflammation, even if I feel well?
- How should we monitor and manage comorbidities like depression, cardiovascular disease, or bone health during remission?
Support and Long-Term Planning
- Are there patient support groups or resources you recommend as I navigate remission and possible flares?
- Can I travel, exercise, or make major life changes, are there any precautions I should take?
Remission as a Journey, Not a Final Destination
Remission in rheumatoid arthritis is one of the most positive, life-changing developments in modern medicine—but it isn’t a finish line or a guarantee. It’s an ongoing process that combines early and effective treatment, careful monitoring, lifestyle balance, and shared decision-making. Whether you’re striving toward remission or lucky enough to have achieved it, living well with RA means staying informed, connected, and proactive.
If you take one thing from this journey, let it be this: remission is a partnership between you, your body, your medical team, and your loved ones. It’s not just about numbers or test results, but about living as fully as possible, day by day.
Talk Over RA is more than a campaign — it’s a call to action. This post is part of the Talk Over RA 2025 campaign and is sponsored by AbbVie. All content and opinions are my own and are not intended to promote any specific pharmaceutical products
Rheumatoid arthritis doesn’t just speak through pain and fatigue, it interrupts plans, drains energy, and creates uncertainty even when symptoms are quiet. The Talk Over RA initiative encourages people living with RA to take back control by speaking up, sharing their experiences, and working with healthcare providers to set meaningful treatment goals.
Don’t forget to download the thoughtfully designed discussion guide to support deeper conversations with your doctor and new ways to share your story. It’s time to make your voice heard.
