My RA is doing fine. Should I decrease the DMARD dose?
Patients with rheumatoid arthritis who are doing well on treatments (DMARDs) often wonder how they would do on a lower medication dose. There have been many studies trying to help answer this question, and they have mostly showed that some patients can decrease or even stop DMARDs for a while, but doing this increases the risk of an RA flare. A recent study published in JAMA added important information to help patients make this decision.
This study enrolled 160 RA patients from Norway who had been in remission (doing great) for 1 year on oral DMARDs (not biologics). Half the group continued the same dose of DMARDs, and the other half decreased their DMARD dose by 50%. The most common DMARD was methotrexate, but some patients were taking leflunomide, sulfasalazine, and/or hydroxychloroquine.
Over the next year, 25% of patients in the half-dose group had an RA flare. Only 6% of patients flared if they stayed on the same DMARD dose. Fortunately, after 1 year 85% of patients in the half-dose group were still in remission compared with 92% of people on the same dose.
This study showed that decreasing the DMARD dose increases the risk for an RA flare, which can cause pain, damage to joints, and potentially lead to taking prednisone to calm the flare. Other studies have reported that some patients who stop a biologic medication and then restart it after flaring won’t get the same good response from that biologic medication, but it is reassuring that most patients who flared because of taking a lower DMARD dose can usually get the disease under control again by going back up on the dose.
Siri Lillegraven, et al. Effect of Half-Dose vs Stable-Dose Conventional Synthetic DMARDs on Disease Flares in Patients With RA in Remission. JAMA. 2021;325(17):1755-1764.