title: Drug-free remission: is it already possible?
abstract: OBJECTIVE
  To give an overview of recently published articles covering drug-free remission in rheumatoid arthritis (RA).
  
  
  RESULTS
  Recent studies covering drug-free remission showed differences in numbers studied, remission definition, disease duration and medication used. Drug-free remission was reported in 9-29%. Only two out of four studies reported on patients who restarted medication due to a disease flare or loss of remission, which occurred in 45-46%. In the BeSt study, remission or low disease activity was achieved again after retreatment within 6 months in 96%. In the Finnish Early Rheumatoid Arthritis study, none of the patients achieved remission after retreatment; their mean Disease Activity Score (DAS28) was 3.68. Joint damage progression was not higher in patients who restarted medication when compared to patients in sustained drug-free remission or patients with continued treatment. Anticitrullinated protein antibody, rheumatoid factor or shared epitope negativity and short symptom duration were independent predictors of successful drug-free remission in more than one cohort.
  
  
  CONCLUSIONS
  Drug-free remission can be achieved and sustained in a small group of RA patients. In early RA, retreatment is successful in the majority of patients. Disease flare after cessation of medication does not seem to increase joint damage progression. Sustained drug-free remission is predicted by autoantibody and shared epitope negativity and short disease duration before treatment initiation.
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands. m.van_den_broek@lumc.nl
authors.forename: Marianne
authors.initials: M
authors.lastname: van den Broek
authors.forename: Tom W J
authors.initials: TW
authors.lastname: Huizinga
authors.forename: Ben A C
authors.initials: BA
authors.lastname: Dijkmans
authors.forename: Cornelia F
authors.initials: CF
authors.lastname: Allaart
mesh_terms: D018501:Antirheumatic Agents / Q000008:administration & dosage; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology; D001323:Autoantibodies / Q000097:blood; D002986:Clinical Trials as Topic; D018450:Disease Progression; D006801:Humans; D011379:Prognosis; D011859:Radiography; D012074:Remission Induction; D057170:Translational Research, Biomedical; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001323:Autoantibodies