My approach to treatment changes for RA patients who are in remission is usually not specific to the kind of medications they are on. Unless the patient has adverse events, I tend to continue the medication or combination of medications that got them into remission. As we know, RA is a chronic cond...

If you believe your patient is in sustained remission, which is difficult to access with certainty, I would slowly decrease the dose, making changes about 6-8 weeks. My usual starting dose is 11mg, so I take it down to 5 mg bid, then 5 then off. At each dose reduction, if there is disease activity, ...

Signs that a patient may be in remission include sustained (for me, > 2 years) normal ESR, CRP, and if at one time RF + a loss of production of the RF. I follow radiographs, and unchanged radiographs after a serial evaluation is helpful. I like ultrasound assessment and look for major sites as ou...