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What Is Remission?

Ankylosing spondylitis (AS) is a chronic rheumatic inflammatory disease that causes arthritis at the base of the spine where it connects to the hips.

The inflammation of AS results in lower back pain in its early stages. Later stages include a range of issues such as morning stiffness, swelling and stiffness in other areas of the body, especially the upper back, neck and shoulders, difficulty sleeping, uveitis, and even inflammatory bowel disease (IBD).

For some people, this long-term inflammation eventually results in the vertebrae in the spine fusing, severely limiting mobility.

However, since AS is an inflammatory disease, in most people the symptoms tend to come and go. Periods, when the pain, swelling, fatigue, and stiffness are stronger, are called flares. Periods when symptoms become something akin to “background noise” are called remission. Your doctor may also call these times of “low disease activity.”1

Remission is always the long-term goal of AS treatment since it allows you to maintain a higher quality of life and preserve as much functional ability as possible.

Diagnosing remission

Unlike with rheumatoid arthritis, there are no definite standards to judge whether you are in remission or not. Your doctor will likely use two different tools to judge whether you are in remission. These tests help your doctor score your AS symptoms.2

These tests are the older Bath Ankylosing Spondylitis Disease Activity Index’ (BASDAI) and the newer Ankylosing Spondylitis Disease Activity Score (ASDAS).3,4

To administer the test, your doctor asks you a series of questions about your levels of pain, stiffness, mobility, and fatigue on a scale of 1 to 10. The lower the total score, the more likely you are in remission.

Your verbal responses are paired with physical tests. These include asking you to touch the floor and measuring the distance between your fingertips and the floor. Your doctor will also request a blood test to measure inflammatory markers in your body and an X-ray or MRI to look for evidence of inflammation in the affected joints.3-5

AS drugs and remission

Just because your symptoms have eased, it doesn’t mean you can quit taking your AS medications. However, your doctor may lower the dosages on some of the drugs you do take. It usually takes some trial and error to find the right balance of medication to keep the flares away while reducing the side effects of the drugs.1

In the early stages of AS, NSAIDs and steroid injections may bring relief, and there is some evidence that NSAIDS slow progression of the disease in some people.6

As AS progresses, TNF inhibitors such as infliximab, etanercept, and adalimumab may be prescribed to help control your symptoms.

One study found that approximately 57 percent of patients experienced partial remission when taking TNF inhibitors. Patients who switched to a different TNF inhibitor because the first didn’t work experienced partial remission 40 percent of the time. Patients with enthesitis (inflammation where tendons or ligaments connect to bone), psoriasis or low C-reative protein (CRP) levels were significantly less likely to achieve partial remission.7

Written by: Jessica Johns Pool | Last reviewed: March 2019
  1. CreakyJoints. Ankylosing Spondylitis Remission. Available at https://creakyjoints.org/education/ankylosing-spondylitis/remission/. Accessed 3/8/2019. 2. Godfrin-Valnet M, et al. Remission Thresholds in Spondyloarthritis: A Prospective Study in Current Practice. The Journal of Rheumatology Mar 2014, 41 (3) 617-618; DOI: 10.3899/jrheum.131092.
  2. Proft F, et al. Ankylosing Spondylitis Disease Activity Score (ASDAS) Based on a Quick Quantitative CRP Assay Performs Similarly Well to ASDAS Based on Conventional CRP in Patients with Axial Spondyloarthritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). Accessed 3/8/2019.
  3. Sieper J. How to define remission in ankylosing spondylitis? Annals of the Rheumatic Diseases 2012;71:i93-i95. http://dx.doi.org/10.1136/annrheumdis-2011-200798. Accessed 3/8/2019.
  4. MD+CALC. Ankylosing Spondylitis Disease Activity Score with CRP (ASDAS-CRP) Available at https://www.mdcalc.com/ankylosing-spondylitis-disease-activity-score-crp-asdas-crp. Accessed 3/8/2019.
  5. Axial spondyloarthritis: is there a treatment of choice? Ther Adv Musculoskelet Dis. 2013 Feb; 5(1): 45–54. doi: 10.1177/1759720X12468658.
  6. Spadaro A, et al. Remission in ankylosing spondylitis treated with anti-TNF-α drugs: a national multicentre study. Rheumatology, Volume 52, Issue 10, 1 October 2013, Pages 1914–1919, https://doi.org/10.1093/rheumatology/ket249
  7. Spadaro A, et al. Remission in ankylosing spondylitis treated with anti-TNF-α drugs: a national multicentre study. Rheumatology, Volume 52, Issue 10, 1 October 2013, Pages 1914–1919, https://doi.org/10.1093/rheumatology/ket249