Clinical Remission and Rheumatoid Arthritis

Remission may as well be an unreachable and unreasonable fantasy for many people with illnesses characterized by chronicity. Sure, people talk about it as a real possibility, but is it? 

Studies show that if a patient is diagnosed in year 1 or 2, and if a patient achieves remission in that period of time, then that patient has a positive prognosis for long-term or short-term remission, even if inconsistent or shallow.

Here is what makes that set of if/thens into an unreachable, unreasonable, BigFoot-like, Lochness Monster-ish phenomenon: the assumptions that accompany every part of the sentence.

Rheumatoid arthritis symptoms can appear individually or together up to ten years prior to diagnosis and before blood tests reveal the hallmarks that lead clinicians to the RA conclusion. A person may have seen a physician for the symptoms. The same person may well have had routine physicals and accompanying blood tests. The diagnosis may still have eluded detection until after the 12-24 month if/then window. Does that mean this patient will never achieve clinical remission? No one knows the answer to that question.

No date-stamp exists on rheumatoid factor (RF) positive results. There is no way to tell how long a person's blood has been RF+. 

Has the gene turned on in the last 90 days? 365 days? Not sure and no way to tell. Routine bloodwork does not include an RF factor test. Further, sedimentation rate (sed rate or ESR), sometimes included in routine blood tests, can be a red herring result often explained away by recent cold, flu, or other viral infection.

Unfortunately, clinical remission of RA is difficult to achieve under any circumstances, but especially challenging with unknown time lines.

So do people, should people, with RA continue to believe in remission with child-like wonder akin to Tooth Fairy tales and Santa Claus culture? 

Isn't it natural to believe that one's life could once again return to a predictable pattern of sameness without daily pain and accommodation that rheumatoid arthritis requires? 

Belief requires the suspension of disbelief because by definition remission is fleeting, unreliable, shallow, and almost surely doomed to fail.

I'll take it--remission- at that price. I will suspend disbelief. I will take fleeting remission, unreliable and imperfect remission. I will take the shallowest of remission and relief of unending pain. I will take a remission doomed to fail any day of the week because the unrelenting pain of rheumatoid arthritis is simply that bad.

I'll take any little bit of relief I can get.