“Remission” is a term used to indicate that there is no longer any detectable inflammatory disease activity. The use of the term “remission” implies that the disease may not be cured, and that relapses are possible in the future. Once a state of remission has been achieved the intensity of immunosuppressive therapy is usually reduced. This means that the dose of prednisone is reduced and that the first-line remission-induction agent (such as cyclophosphamide) is replaced by better-tolerated, milder forms of immunosuppression that are used more long-term to keep the patient in remission (such as methotrexate, azathioprine, or mycophenolate mofetil).
“Remission” does not necessarily mean that the patient is feeling perfectly well. This is because symptoms may be caused by either active inflammation associated with vasculitis, or by organ damage resulting from active disease or by side effects of medications used to put the patient in remission. “Remission” also does not mean that all serological markers of a specific form of vasculitis (such as ANCA or ESR) have completely disappeared or normalized.
The concept of “remission” is often expanded through use of the terms “partial remission”, “complete remission”, or “sustained remission”. Partial remission means that the disease has improved but that there is still some detectable inflammatory activity in at least some of the organs afflicted by the disease before treatment was started. Complete remission means that there is no more inflammatory activity detectable in any of the affected organs. Sustained remission implies that the state of complete remission has been maintained for at least six months.
A patient can be in remission on medication or off all immunosuppressive medications. The ideal state, of course, is to have experienced a sustained complete remission lasting long enough to allow for discontinuation of all immunosuppressive therapy and maintaining that state long-term without suffering a relapse.
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