Reaching for Remission in Rheumatoid Arthritis

Thanks to greater scientific understanding developed over the past two decades, rheumatoid arthritis remission is now a more achievable goal

Envisioning a Different Future

By the time she visited Dr. Aileen Pangan’s clinic, the patient arrived in a wheelchair. Rheumatoid arthritis — a chronic autoimmune disease that can progress to permanent, debilitating bone and cartilage damage — had destroyed her hips, both of which had been replaced.

Dr. Pangan, a rheumatologist and AbbVie’s executive medical director in immunology clinical development, remembers the patient well because the patient’s main concern was not for herself, but for her 19-year-old daughter who had recently been diagnosed with the same disease.

"Will she end up like me?" Dr. Pangan remembers the mother asking her. "Will she also be in a wheelchair by the time she gets to my age?"

With today’s therapies, Dr. Pangan says patients with rheumatoid arthritis have a better chance at reaching remission. Yet not everyone will reach this goal; many people will achieve only low-disease activity, Dr. Pangan says. One in three people who have rheumatoid arthritis alternate between relapse and remission regardless of therapy, according to an Arthritis Foundation article.1

To improve those odds, scientists, health care providers and patient advocacy groups continue to strive for a future where remission is within reach for as many people as possible.

“If the disease is diagnosed and treated appropriately early, there’s a better chance to get the disease under control and to reduce or prevent irreversible joint damage,” says Ailsa Bosworth, MBE, founder of the UK’s National Rheumatoid Arthritis Society, who has lived with rheumatoid arthritis for nearly 40 years.

The Road to Remission

When people hear the word remission, the first disease that often comes to mind is cancer. But remission is achievable in many chronic diseases, including rheumatoid arthritis and other autoimmune diseases.

When physicians talk about remission in rheumatoid arthritis, Dr. Pangan says, they’re referring to the absence or rare reoccurrence of the signs and symptoms of inflammation, including joint pain, joint tenderness and morning stiffness.1,2,3 Remission is the primary treatment goal for patients with rheumatoid arthritis because no therapy at this time can lead to a cure. Even if patients achieve remission, the symptoms may come back.

“To people living with rheumatoid arthritis today, remission means having prolonged periods of being able to return to everyday activities, without having to think about and accommodate their disease,” Bosworth says.

Blocking Inflammatory Pathways

Multiple risk factors, including family history, genetic and environmental factors may play a role in the onset of rheumatoid arthritis. The immune system is activated against the joints and leads to inflammation, which is critical to the progression of the disease. Scientists have identified different pathways of inflammation which may not be exactly the same for each and every rheumatoid arthritis patient. This may be one of the reasons why patients have varying responses to therapies.

“We continue to do research to better understand rheumatoid arthritis and figure out what pathways we can target. Each patient responds differently to treatments and we need more options that can help patients achieve remission,” Dr. Pangan says.

Marwan Bukhari, Ph.D., FRCP, a rheumatologist in the U.K. whose daily work involves deciding which medicine targets the right pathway for patients, says that health care providers are now better at eventually combating inflammation, but don’t have the tools to quickly decide which medicine will work when a patient first visits the clinic. He looks forward to the day when a biomarker can provide information about how patients will respond to a given therapy.

“This would really help identify people with moderate disease or whose symptoms are not obvious,” Dr. Bukhari says.

A Powerful Message

Dr. Pangan recalls another patient she saw in her practice.

The patient had lived with rheumatoid arthritis for many years. When she finally got a treatment that worked for her and achieved remission, she came back to the clinic with a powerful message. It’s a message that has stuck with Dr. Pangan.

“She told me she never knew how sick she was until she got better. She forgot what it meant to feel normal,” Dr. Pangan says. “With greater awareness of rheumatoid arthritis and a focus on advancing our scientific understanding of the disease, I am hopeful more patients can get back to feeling normal.”

Arthritis Foundation. “Why Your RA Went Into Remission, but Relapsed.” https://www.arthritis.org/living-with-arthritis/treatments/plan/remission/rheumatoid-arthritis-remission-and-relapse.php. Accessed on March 11, 2019

Mayo Clinic. Rheumatoid Arthritis: Symptoms & Causes. Available at http://www.mayoclinic.org/diseases-conditions/rheumatoidarthritis/home/ovc-20197388. Accessed on March 11, 2019.

3 American College of Rheumatology. “Rheumatoid Arthritis.” Available at: https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Rheumatoid-Arthritis. Accessed March 11, 2019.