Psoriatic arthritis (PsA) is an autoimmune condition with alternating cycles of flare-ups, when joints become stiff and swollen, and remission, when symptoms resolve for a time. Each person with psoriatic arthritis experiences symptoms differently. Some develop psoriasis plaques on their skin during PsA flares, others notice symptoms on their nails or swelling in their fingers or toes — and most have pain in their joints and tendons.

Because PsA can show up in so many ways, rheumatologists use a variety of assessments to understand when remission has been reached. Read on for more about how to tell if your PsA is in remission and which PsA treatments can best help keep symptoms at bay.

What Is Remission?

Because so many symptoms are associated with PsA, there is no specific definition of remission for the condition. Instead, doctors may use the terms “minimal disease activity” (MDA) or “very low disease activity” (VLDA) when talking about remission. People with MDA or VLDA have little to no pain in their joints or tendons, few signs of psoriasis on their skin or nails, and an overall good quality of life.

Remission can be drug-induced, meaning you will have low disease activity as long as you stay on your prescribed treatment plan. Remission can also be drug-free, requiring no medication to maintain, but this type is uncommon for people who have been diagnosed with PsA.

How Is Remission Identified?

Your doctor can evaluate your PsA using several methods. They will look for symptoms of disease activity, including:

• Psoriasis plaques on the skin
• PsA on the nails, such as pitting, discoloration, or splitting
• Enthesitis (inflamed tendons)
• Dactylitis (swelling of the fingers or toes)
• Spondylitis (arthritis symptoms in the spine and hips)
• Pain and swelling in any joints
• Fatigue
• Eye inflammation, pain, or redness

Your doctor will ask you to describe the locations of your joint pain and any symptoms you’ve noticed. They’ll want to know if you feel any morning stiffness in your joints when you awaken.

Your doctor may also use various assessment tools to better understand your disease activity, such as:

• A joint count of tender and swollen joints
• A blood test for C-reactive protein (CRP) levels and erythrocyte sedimentation rate (ESR), which are markers (indicators) of inflammation
• Psoriasis Area and Severity Index score
• The Health Assessment Questionnaire

By evaluating your symptoms, test scores, and blood work results, your doctor can get an overall sense of your disease activity and how close you may be to remission. They will likely begin to use these tools at the onset of your disease because tracking the trends of these markers can be useful for predicting prognosis (disease course).

Psoriasis Arthritis Treatment and Remission

Currently, there is no known cure for PsA. Rheumatologists’ goal for treatment is to help people have a good quality of life and aim for the lowest disease activity possible. This involves not only controlling pain and joint damage but also managing any skin symptoms. Lower disease activity indicates that there is less ongoing inflammation in the musculoskeletal system. That means the risk of long-term disease consequences, such as deformed joints or disability, is lower.

Whether your PsA goes into remission depends on your symptoms and how well your condition responds to treatment. Rheumatology research has shown that those who have mild or early PsA, or those who are involved in a rigorous strategy called treat-to-target, see better rates of remission.

Treat-to-target therapy uses four components to guide the treatment plan:

• Setting a specific target, likely combining some of the tools discussed above (e.g., lowering CRP levels or reducing the tender/swollen joint count)
• Testing on a regular basis, with more frequent follow-up visits (e.g., monthly instead of quarterly)
• Modifying drugs, doses, or other factors if progress is not made toward the target
• Sharing decision-making, with the doctor and the person being treated working together

DMARDs for Psoriatic Arthritis

Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil) or naproxen (Aleve), may help ease mild joint pain, but they can’t slow disease activity or lead to remission. Disease-modifying antirheumatic drugs (DMARDs) are the only approved treatments that can slow the progress of PsA.

Conventional DMARDS, like methotrexate (Otrexup, Rasuvo, Trexall) or sulfasalazine, work by suppressing the entire immune system. Biologic DMARDs change specific immune-system pathways with a more targeted approach. You may need to try more than one treatment option to find the DMARD that works best for you.

Research shows that some people with PsA who do not respond to conventional DMARDs have success with biologic therapies called tumor necrosis factor (TNF) alpha inhibitors. These include:

• Adalimumab (Humira)
• Etanercept (Enbrel)
• Infliximab (Remicade)
• Golimumab (Simponi)

In one study, 58 percent of 152 participants with PsA experienced remission after one year on TNF inhibitors. Another study found that taking golimumab plus methotrexate significantly increased the rate of remission for people in the early stages of PsA. Your rheumatologist may have you continue with your conventional DMARD, such as methotrexate, even if another drug is added.

For people who have more severe skin symptoms of psoriasis in addition to PsA, a type of biologic called an interleukin inhibitor may be recommended. Many interleukin inhibitors have been approved to treat PsA, including:

• Secukinumab (Cosentyx)
• Brodalumab (Siliq)
• Ustekinumab (Stelara)
• Ixekizumab (Taltz)

Biologics are usually taken long term to keep disease activity low. It can take a few months for DMARDs to become effective, but if a prescribed biologic doesn’t start working for you, your doctor may suggest switching to a different drug. Your doctor can help you find the treatment plan that will help you control your PsA symptoms and offer the best chance of achieving remission.

How Long Does Remission Last?

PsA is unpredictable, and it can be difficult to plan for the quiet periods between disease activity. Remission can last for days or for years.

Even after you’ve achieved minimal disease activity, you may need to maintain your treatment plan to avoid a recurrence. Working closely with your rheumatologist is highly recommended, no matter what stage your PsA is in.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and psoriatic arthritis and their loved ones. On MyPsoriasisTeam, more than 113,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriatic arthritis.

Have you experienced psoriatic arthritis remission? What has helped you manage your psoriatic arthritis? Share your experience in the comments below, or start a conversation by posting on your Activities page.