Rheumatoid Arthritis: The journey from ‘no treatment’ to ‘drug free remission’

Not bothered about me crying in pain,
That Physician with great name & fame,
Gave the disease he cannot cure,
A name!

Is this what Rheumatoid Arthritis treatment all about?
Are Rheumatologists just giving name to a disease for which they do not have any treatment & cure?
Mind you, these lines were penned almost 150 years back.

We have come a long way since then.
In the early years, symptomatic therapy (pain control & patient’s feeling of well being) was all that was available. We had aspirin & steroids. Slowly multiple other anti inflammatory meds became available; but the treatment concept remained the same.

Slowly, the destructive potential of rheumatoid arthritis was realised. This stimulated the search for means to modify the disease course. This is when DMARDs (Disease Modifying Anti Rheumatic drugs) came into the picture. Armed with evidence, Rheumatologist shifted gears from the ‘conservative wait & watch’ approach to the much more aggressive ‘early diagnosis, early aggressive targeted treatment’. This literally translated into ‘will not tolerate any harm’ approach. Biologics came in handy for Rheumatologists to achieve this goal.

The change in mindset coupled with effective medicines enabled us to aim for remission in a disease that was thought to be the one without effective treatment.  Recent studies have already shown that even ‘drug free remission’ is possible.

The existence of ‘drug free remission’ was discussed at length at this year’s American College of Rheumatology Conference. Doubts about its real world definition, longetivity, recurrence of RA definitely do exist.

Nevertheless, we have come a long way; from ‘no effective treatment’ to ‘drug free remission’ Collateral damage in the form of cardiovascular events, osteoporosis is also well recognised & prevention strategies are getting refined. Patients be rest assured that better things are in store for them.

Few years from now & you may find me tweeting & blogging about sustained drug free remission. All the very best & wish everyone remission……


  1. My rheumatologist is very enthusiastic about what a great time this is in the history of rheumatoid arthritis, because he is able to do so much more than in the past, using the new drugs. I have met a few elderly ladies who are very affected by long term RA and I am reasonably sure that I will never have those deformities that used to be the norm.

    When I was diagnosed it was pre methotrexate and I was treated with gold injections. My GP who did the injections used to say I had a valuable butt. Not so funny when you figure he was the one who missed my diagnosis until I got the answer from an orthopedic surgeon.

    So I totally agree with you and hope you do see the drug free remissions in your practice. They say rheumatologists are the happiest category of specialist and that will make you even happier, eh? (Canadian term)



    1. Yes indeed. Rheumatologists are a happier lot now with the effective DMARDs, biologics. So much more can be done for the patients with these meds.

      Classic deformities are not seen commonly & we are able to achieve remission in quite a few patients.



    1. Dear Brian,

      We have reached a stage wherein we are achieving ‘drug free remission’. What is meant by this term is that patients have been in remission for quite some time, DMARds have been tapered & stopped; they are doing well even after stopping the meds. This stage is not a short lasting one, but for a period of years.

      Cure is a very technical term. “Drug free remission’ is the closest we can get to cure.

      Starting from ‘disease without any treatment’ to ‘only symptomatic relief’ to ‘controlling the disease with meds’ to ‘remission’ to ‘drug free remission’ is a major advance.

      We have not achieved/ claiming a cure for RA; but we have achieved/ advanced a lot. May be, sometime down the line, even cure may be a possibility.



  2. Thanks Dr.!! Encouraged to hear the possibility of “drug free remission ” Under your treatment the day is not far off when my wife will be in the stage of “drug free remission ”

    Thanks a lot for encouraging the patients and helping each and every patient of RA by caring and guiding at every time.



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  5. I am one of those people who were lucky enough to have a “drug free remission.” After 9 years of very painful, often disabling RA flares–even though I’d taken every NSAID out there at the time, along with Plaquenil and oral gold–I stopped taking all medications. Frankly, I was tired of the side effects (mainly a sick stomach) and afraid of more serious side effects, such as killing my liver. Over the next couple of years my flares grew fewer and fewer, slowly ebbing in intensity. And then they stopped. Entirely.

    Amazing. For the next six years I had only two flares. Both were painful, but last only about 12 hours each. And they were several years apart.

    In 2005 my RA reappeared. Today I take three DMARDs, my disease is slowly worsening, and I’m considering a biologic. This note is not to complain, but to perhaps give others hope. There IS such a thing as a drug-free remission. However, it’s a good idea to remember that the remission does not mean that the disease is cured. Still, how wonderful those years without pain and disability were! I am still grateful.

    Thank you for writing about this subject, Dr. Akerkar. Know hope.



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