A Promising Science-Based Approach to PsA Remission

Remission is possible, but finding the right treatment is a journey that takes time and patience.

At my first office visit, my rheumatologist spent 45 minutes with me, patiently answering my questions about treatment options and disease progression. At that time, I had very minor symptoms of psoriatic arthritis (PsA) and was not a candidate for treatment beyond over-the-counter (OTC) anti-inflammatories and at-home treatments.

My doctor reassured me that everyone’s experience with PsA is different and that my symptoms might remain mild throughout my lifetime. And then, right before our appointment ended, he dropped the R-word: remission. “You might even go into remission someday,” he said casually.

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Could PsA remission be a possibility?

Remission? If you’re like me, you may only associate this word with cancer treatment. But once my doctor mentioned it, the magical thinking began.

I wondered: Could my PsA disappear one day? Could I go into remission? I began to imagine a future without the aches and pains, without the fatigue and irritated, flaky skin. I wondered what it might be like without the constant worry about my symptoms getting progressively worse. So I did some research on the possibility of PsA remission and how one might usher it in. That’s where the magical thinking ended.

A realistic approach to life with PsA

What I realized, first and foremost, is that I had a rather limited concept of what “remission” actually meant. I understood that remission was the lack of evidence of disease, but in my fantasy, it was something permanent.

Remission was divine in my mind, miraculous: the body rebalancing itself; the immune system functioning normally again, fighting disease — not creating disease, as it does with PsA and other autoimmune illnesses. But actually, that’s not what remission is.

The definition of remission is “a lessening in the severity of symptoms or their temporary disappearance during the course of an illness.” The words “lessening” and “temporary” stood out like sore, psoriatic thumbs.

Some part of me already knew that remission was possible only with proper medical treatment and only if someone stayed on that treatment path (hence the word “temporary”). But as I dug deeper, I came to understand that there’s really no guarantee at all that one will stay in remission.

Research suggests that people with PsA who stop treatment, even after several years in remission, will not remain there without continuing medication. All the research I found emphasized this caveat, and I could find no evidence of PsA symptoms resolving on their own.

However, when someone’s PsA is in remission, it means their symptoms are resolved, often completely, and there is no further development of functional or structural joint damage. It’s important to note here that joint damage that occurs prior to remission will be permanent, but medication can stop further damage from occurring. And with the right meds, PsA remission is quite common.

A trial-and-error journey

Many people with PsA can reach remission status when they have the right medication. But, as usual with PsA, it’s not quite that simple, because finding the right medication to relieve PsA symptoms is a journey in and of itself.

Many people try several different medications before they find the one that works for them, and it can take months before each medication begins to work. This trial and error can go on for more than a year.

The good news is that evidence of medically induced remission with immune-suppressing medications has been found in studies as far back as 2011, and recent studies suggest that remission rates can be as high as 90%.

Also, medication options have grown exponentially in the last decade, ushering in a range of new disease-modifying antirheumatic drugs (DMARDs) such as Otezla.

Some DMARDs are injectable, which means you won’t have to take a pill every day — you can receive the injections at your doctor’s office or self-inject at home.

Some of these fall into the category of biologics, including medications you may have heard of, such as Humira and Enbrel. These DMARDs target different parts of your immune system, giving you more options for getting into remission. And recent research suggests that these drugs are even safer than previously thought.

Checking in with yourself

I’m still at a stage in my disease where I have only minor flares, which I can manage with OTC (and occasionally prescription) anti-inflammatories, as well as mindfulness around rest, stress reduction, diet, and exercise. But over the last few years, I’ve noticed a mild yet steady progression, and I’ve begun to seriously consider talking with my rheumatologist again about trying a DMARD in the near future.

Everyone’s progression is different, and many factors can increase flares and discomfort, but when your flares become more frequent or the intensity of your symptoms increases, it may be time to rethink your treatment plan beyond anti-inflammatories and the occasional steroid shot.

The good news is that there are more treatments now than ever, and with those treatments, remission is a real possibility.

Talk with your doctor about treatment options that are right for you. Starting treatment earlier may prevent possible permanent and irreversible joint damage. The longer you wait, the higher the disease burden may be when you start treatment. Drugs may be more effective if treatment begins early.

A few takeaways

You don’t have to live with pain and discomfort or the worry that your disease will only get worse. Remission with PsA is possible, and studies suggest that it’s likely in up to 90% of people who take DMARDs.

Once you find the right treatment and stay on that treatment consistently, you can stay in remission, get consistent relief from your symptoms, and potentially prevent future disease progression.

Because DMARDs affect various parts of your immune system, you may have to try a few different ones, and each one may take several months to show results.

Finding the right treatment can take time, so be patient and work closely with your rheumatologist to find the right medication for you.