Tuesday, November 11, 2008

Remission in Behcet's

Are you in remission right now? It might seem like you could give a simple "yes" or "no" answer, but in a lot of cases, it's not that easy. Why not?

Because it's a matter of definition. Here's another question:

Are you in a remission because you're taking drugs right now that keep you from having flareups?
Or are you off all drugs, and still symptom-free?

And then there's the question of time. How long have you been flare-free? Two weeks? Two months? Two years? What's the minimum amount of time to be flare-free before you can say you're in remission? And are you free of all symptoms?

Over the years, I've lost count of the number of people who have told me that they're in remission -- but when I ask if they still get mouth ulcers, they say, "Every once in a while." Do their joints hurt? "Sure, but it's not too bad." I think you get the idea. I don't count that as remission.

Luckily, there are experts out there that are thinking about this whole issue of remission. There's a 120+-page supplement to the Clinical & Experimental Rheumatology journal available online, for free, about Remission in Rheumatic Diseases. Behcet's isn't the subject of any of the articles (many concentrate on rheumatoid arthritis), but one article in particular is worth downloading:

Complexities in defining remission in rheumatic diseases
Clinical and Experimental Rheumatology, 2006;24;6;43, Pg. S001-S006
T. Pincus, A. Kavanaugh, D. Aletaha, J. Smolen

Some of the questions it tackles:
1) What's the time-frame required to say that you're in remission?
2) Is remission with or without medication?
3) Can you be considered in remission if you have organ damage caused by past inflammations?
4) What about spontaneous remission?
5) Is "near remission" (where your disease is at a low level of activity) a better goal for many patients, instead of shooting for a full remission?

This article (and the whole 120+ page supplement, as a matter of fact) can be accessed for free now, but I don't know how long it will be available. I suggest taking a look at it (and downloading or printing it out) while you have a chance.

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