Hands emerging from water, symbolizing remission from Rheumatoid Arthritis.

RA Remission: Is Drug-Free the Future?

Samir D’Costa in Health & Wellness December 2025 • 3 min read.

"New research explores the potential for suspending medication in early rheumatoid arthritis patients who achieve sustained remission, but autoimmune activity may predict relapse."

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation of the joints, leading to pain, swelling, and stiffness. Early diagnosis and treatment have revolutionized RA management, with many patients achieving remission through disease-modifying antirheumatic drugs (DMARDs).

The ultimate goal for many RA patients is to achieve drug-free remission, where the disease remains controlled even after stopping medication. However, predicting which patients can successfully discontinue DMARDs remains a challenge.

Recent research presented at the European League Against Rheumatism (EULAR) annual meeting sheds light on the possibility of DMARD suspension in early RA patients who have achieved sustained remission. This article will delve into these findings, exploring the potential for drug-free remission and the factors that may influence disease relapse.

DMARD Suspension: A Realistic Goal?

Hands emerging from water, symbolizing remission from Rheumatoid Arthritis.

The study, presented at EULAR, investigated the outcomes of methotrexate (MTX) suspension in early RA patients who had achieved sustained remission after DAS-driven therapy. DAS, or Disease Activity Score, is a measure of RA disease activity. The study aimed to identify predictors of disease recurrence after stopping DMARDs.

Researchers followed 70 RA patients from the Pavia's Early Arthritis Clinic (PEAC) who met specific criteria for drug suspension:

Fulfillment of the 2010 ACR/EULAR classification criteria for RA within 12 months from baseline visit.
MTX introduced within 12 months from symptom onset.
≥24 months of continuous MTX treatment.
DAS28 remission (disease activity score) documented for ≥6 months in the absence of glucocorticoids.

After a median follow-up of 6 months, the results showed that 28 out of 63 patients (44.4%) experienced disease recurrence and required retreatment. This highlights that while DMARD suspension is possible for some, it's not a guaranteed success for all.

Looking Ahead: Personalizing RA Treatment

While the study provides valuable insights, it also underscores the complexity of RA management. The decision to suspend DMARDs should be made on a case-by-case basis, considering individual risk factors and the potential for disease flare. Further research is needed to refine our understanding of these factors and develop more precise strategies for identifying patients who can safely achieve drug-free remission.

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Everything You Need To Know

What is Rheumatoid Arthritis (RA) and how is it typically managed?

Rheumatoid Arthritis (RA) is a chronic autoimmune disease characterized by inflammation of the joints, resulting in pain, swelling, and stiffness. Early diagnosis and treatment have significantly improved RA management. Many patients can achieve remission through the use of Disease-Modifying Antirheumatic Drugs (DMARDs). The goal is often drug-free remission, where the disease remains controlled even after stopping medication.

What are Disease-Modifying Antirheumatic Drugs (DMARDs) and their role in RA treatment?

Disease-Modifying Antirheumatic Drugs (DMARDs) are a class of medications used to treat Rheumatoid Arthritis (RA). They work by suppressing the immune system and reducing inflammation, which helps to slow the progression of the disease and alleviate symptoms such as joint pain, swelling, and stiffness. Methotrexate (MTX) is a common DMARD. These drugs are critical in helping patients achieve remission, a state where the disease is under control.

Can patients with early Rheumatoid Arthritis safely stop their DMARDs, like Methotrexate (MTX), and maintain remission?

The possibility of suspending DMARDs, like Methotrexate (MTX), in early Rheumatoid Arthritis patients is explored in recent research. While some patients may achieve drug-free remission, it's not guaranteed. A study followed early RA patients who had achieved sustained remission after DAS-driven therapy. After a median follow-up of 6 months, 44.4% of patients experienced disease recurrence and required retreatment. The decision to suspend DMARDs should be individualized, considering factors like disease activity and potential for flare-ups.

What criteria did the study use to determine if early RA patients could suspend Methotrexate (MTX)?

The study, conducted at the Pavia's Early Arthritis Clinic (PEAC), used specific criteria for Methotrexate (MTX) suspension. Patients had to meet the 2010 ACR/EULAR classification criteria for RA within 12 months from the baseline visit. Additionally, Methotrexate (MTX) had to be introduced within 12 months from symptom onset. Patients needed to have at least 24 months of continuous Methotrexate (MTX) treatment and DAS28 remission (disease activity score) documented for at least 6 months without glucocorticoids.

What are the implications of disease recurrence after DMARD suspension for Rheumatoid Arthritis (RA) patients?

Disease recurrence after stopping DMARDs, such as Methotrexate (MTX), means that Rheumatoid Arthritis (RA) symptoms return, indicating the disease is active again. Patients may experience a return of joint pain, swelling, and stiffness. In the study, those with recurrence required retreatment. This highlights the complexity of RA management and the need for individualized treatment strategies. It underscores that while drug-free remission is a goal, it's not suitable for everyone. Factors influencing disease relapse after stopping DMARDs must be carefully considered.