Remission Myths and Misconceptions, with Dr. Loreto Carmona
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Remission Myths and Misconceptions, with Dr. Loreto Carmona

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Summary:

On this special episode of ‘Rheumer has It’, hosts Eileen and Cheryl are joined by renowned rheumatologist Dr. Loreto Carmona from Spain. The discussion centers around the concept of remission in rheumatoid arthritis (RA), highlighting the differences between medical and patient perspectives on what constitutes remission. Dr. Carmona emphasizes the importance of communication between patients and doctors, the role of medications and lifestyle factors, and the myths surrounding RA remission.

This insightful conversation is part of the Canadian Talk Over RA campaign, aimed at providing hope and clear knowledge to those living with RA. This is episode 188 of the Arthritis Life Podcast and number 8 of Rheumer has It.

Episode at a glance:

  • 00:31 Meet Dr. Loreto Carmona
  • 01:31 Defining Remission in Rheumatoid Arthritis
  • 04:26 Misconceptions About Remission
  • 07:38 Factors Influencing Remission
  • 11:30 The Importance of Communication
  • 14:48 Historical Perspectives on RA Treatment
  • 16:12 Final Thoughts and Resources

Medical disclaimer: 

All content found on Arthritis Life public channels (including Rheumer Has It) was created for generalized informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Episode Sponsors

Rheum to THRIVE, an online course and support program Cheryl created to help people with rheumatic disease go from overwhelmed, confused and alone to confident, supported and connected. See all the details and join the program or waitlist now! 

Special Episode Sponsor: Talk Over RA Campaign

AD – Talk Over RA is more than a campaign — it’s a call to action. This podcast episode is part of the Talk Over RA 2025 campaign and is sponsored by AbbVie Canada. All content and opinions are Eileen Davidson, Cheryl Crow and Dr. Loreto’s own and are not intended to promote any specific pharmaceutical products.

Rheumatoid arthritis doesn’t just speak through pain and fatigue — it interrupts plans, drains energy, and creates uncertainty even when symptoms are quiet. The Talk Over RA initiative encourages people living with RA to take back control by speaking up, sharing their experiences, and working with healthcare providers to set meaningful treatment goals.

Eileen’s role in this campaign is to provide tools that help you prepare for appointments, explore what remission could look like, and connect with others who truly understand. 

Don’t let RA speak louder than you. Explore the campaign and download the guide here. 

#TalkOverRA #RheumatoidArthritis #ChronicIllness #RAAwareness #Arthritis #RheumatoidArthritisWarrior #RheumatoidArthritisAwareness 

Speaker Bios:

Loreto Carmona

Loreto Carmona is a rheumatologist, clinical epidemiologist, and rheumatology advocate. She worked at the Spanish Medicines Agency as an NHS researcher and a full-time rheumatologist, and created and directed the Spanish Society of Rheumatology Research Unit. From Valencia (Spain), Loreto leads the Institute for Musculoskeletal Health (Inmusc, Madrid). She has published over 400 papers and participates in numerous Spanish and European projects and courses. She has been on the board of national patients’ and health professionals’ organisations.

Eileen Davidson Bio

Eileen Davidson, also known as Chronic Eileen, is a disability and chronic illness advocate from Vancouver BC Canada. Living with a diagnosis of rheumatoid arthritis, she spends a large focus on volunteering and creating awareness around arthritis. With The International Foundation for Autoimmune and Autoinflammatory Arthritis (AiArthritis) Eileen is the Educational Media Assistant. Along with AiArthritis, Eileen is a member of the Arthritis Research Canada patient advisory board, and author with over 100 published articles.

Cheryl Crow

Cheryl is an occupational therapist who has lived with rheumatoid arthritis for over twenty years. Her life passion is helping others with rheumatoid arthritis figure out how to live a full life despite arthritis, by developing tools to navigate physical, emotional and social challenges. She formed the educational company Arthritis Life in 2019 after seeing a huge need for more engaging, accessible, and (dare I say) FUN patient education and self-management resources.

Full Episode Transcript:

[00:00:00] Eileen Davidson: Welcome to Rheumer has It, the podcast that busts myths, highlights evidence and inspires hope for living better with rheumatic disease.

[00:00:07] Cheryl Crow: Through plain language interviews with experts, we offer actual knowledge so you can thrive today.

[00:00:12] Eileen Davidson: My name is Eileen.

[00:00:14] Cheryl Crow: My name is Cheryl.

[00:00:15] Eileen Davidson: Join us as we bust myths and spotlight evidence, and today we have a special episode continuing the fifth year of the Canadian Talk Over RA campaign sponsored by AbbVie. However, we are not discussing drugs by name, but here to educate you on what remission is.

So we are so happy to have a rheumatologist from Spain that I met while attending the 2025 European Rheumatology Conference in Barcelona earlier this year.

Welcome, Dr. Loreto Carmona here to talk about remission and rheumatoid arthritis. Can you first let us know a little bit about your training and how you came to specialize in remission with rheumatoid arthritis? ‘Cause you are considered an expert in it.

[00:00:53] Dr Loreto Carmona: Sure. Hello everybody. So I always wanted to be a doctor and then when I had to choose, I always wanted to have something that is related to psychology kind of, but also immunology. So then I realized rheumatology was the perfect match for me. So that’s how I came to rheumatology.

[00:01:17] Cheryl Crow: That’s amazing. I also love psychology too. So I think a lot of rheumatologists are very, you know, person centered. They love the relationships with their patients, and I always, as a patient myself, I enjoy that.

So before we talk about remission, we have to actually define what remission is. Is there one unified definition or how do you define remission in rheumatoid arthritis?

[00:01:45] Dr Loreto Carmona: Well, there is not a unified definition. We can say that is the absence of symptoms. Yeah. But it’s not only that, it’s it’s more, and depending on whether you look at remission from a rheumatologist perspective or from a patient perspective or even from a radiologist perspective, it might change a little.

But basically is the complete absence of of symptoms. That’s what it is, more or less.

[00:02:20] Cheryl Crow: That makes a lot of sense. And just a quick follow up question. I’ve heard sometimes that someone, some patients feel like their doctor thinks that they’re in remission because their blood work looks good, or their imaging looks good, but the patient still has symptoms so they don’t feel like there’s remission.

That’s almost like a little bit of one of these communication- do you think that’s like a communication issue or has, have you ever experienced that?

[00:02:46] Dr Loreto Carmona: Yeah, absolutely. So, you know, every we are all humans, right? And it’s not easy. And as, as you mentioned, communication is a big issue in medicine.

So the problem is that the symptoms of our diseases are, most of them are subjective. So I cannot be in your shoes, and I cannot really know whether everything is is away, all the symptoms are away. You tell me that you have pain. And if I’m empathetic enough, I can say, okay the disease is not in remission because this patient still has pain.

But we have other rheumatologists who are not so empathetic I will say. And think that this pain is not only related to the disease itself, but it might be related to other things. Like, I don’t know, we talk about psychological aspects. So if you are depressed, everything can actually hurt.

So, I don’t know whether you, you’ve ever been heartbreak but it, it hurts. So if you’re depressed, everything hurts. And it’s not easy to know whether that is because of the disease or is it because of your depression. And there there are this set of things. That you know, make us difficult to say whether a patient is in remission or not.

But yeah, we should listen more to the patient and take that pain into consideration. Yes.

[00:04:10] Cheryl Crow: Tha thank you so much. Eileen has the first misconception to help clear up.

[00:04:17] Eileen Davidson: That was wonderful and I think it is so important to address the emotional side to living with pain. So great definition there.

Now, remission. There’s a misconception that remission is being cured. How would you say that is untrue or true?

[00:04:34] Dr Loreto Carmona: We wish it, it were true. Yes. So usually remission only a few lucky ones have remission just forever, right? But usually what happens is that you enter into remission, you have no symptoms, and then this is usually temporary.

There are some patients that can be off medication so they can be put off medication even for long periods of times. But the majority of them return to have what we call flares or more symptoms after a while. So we are always trying to fix the treatment so that you don’t have to take a lot of treatment if you are in remission, but then be alert of the symptoms of a flare coming back.

So, yeah, unfortunately it’s not the cure.

[00:05:24] Cheryl Crow: Yeah that’s really helpful to know. And I think on a related note, there’s also a misconception that anyone can reach remission without medication. Because some people do have an unmedicated remission for whatever reason, and they’ll say things like, I did it, you can do it too. What would you say to that? Is that right or wrong?

[00:05:49] Dr Loreto Carmona: Well, if we look at the data that will happen in less than 5% of the people. So, if you are one of those lucky ones, I mean, you should know that the rest of the people are not so lucky. So you should not be, you know, blaming on the others.

[00:06:09] Cheryl Crow: Sorry. I was gonna say, do you mind letting people know a couple of the things that make someone less likely to be able to get into remission?

[00:06:19] Dr Loreto Carmona: I wish we knew. I wish we knew. Okay. The thing is that if we were able to predict beforehand just by drawing a blood test or by getting some clinical record taking and say, okay, this person is going to enter remission if I put this person on this drug, or even if I don’t put this person on any drug, then that will be, that’s my dream.

Yeah, that’s my dream. Everybody’s dream. But so far we do not have that. It is not possible to know who is going to go well or who is not. We have some poor prognostic factors. But for good, we don’t have them.

[00:07:00] Cheryl Crow: Oh, interesting. Okay. I thought I had heard, but let me know, maybe we can correct a misconception in real time that I thought I’d heard something that if you, the faster that you get to your diagnosis, like in the least amount of joints that you have affected initially, like if you only had one swollen joint and you caught it really early, then you’re more likely to get in remission.

Or is that a misconception?

[00:07:24] Dr Loreto Carmona: I mean, that’s a good sign. It’s a good sign, but that doesn’t mean that you will be in remission forever.

[00:07:29] Cheryl Crow: Oh, I see. So it’s not like a guarantee. You’re showing us how rheumatologists are detectives. You’re always having to gather evidence. I love it. Thank you so much. Okay. I’m gonna let Eileen go.

[00:07:38] Eileen Davidson: No, this one actually ties right into what you were both just talking about, because our next misconception about remission is the likelihood of remission is the same for everyone with the same diagnosis.

So can you walk us through some of the reasons why somebody might not achieve remission right away, or maybe it takes them a long time or maybe, unfortunately they never do achieve remission.

[00:08:04] Dr Loreto Carmona: I mean there are a lot of research on the way looking at the molecules with directly in the joint, okay? So the, at the end it will be a combination of genetics how the molecules behave in our joints and in our bodies.

Everything that happens around safe stress things that can trigger a flare. So, usually when the disease is very clear, we can more or less anticipate, but each patient is completely different.

We still are not at that point where we can say, this patient is going to get into remission, this patient is not. We can as I said before, we can give hope, but we cannot guarantee.

[00:08:50] Cheryl Crow: That makes sense. Yeah. I think as a patient, that can be one of the hardest things to cope with is that uncertainty. We all want the guarantee, but but we have to learn to cope with uncertainty.

[00:09:01] Dr Loreto Carmona: I have a trick for that.

[00:09:02] Cheryl Crow: Oh yeah? Tell me.

[00:09:03] Dr Loreto Carmona: Yeah. Because I lived in San Francisco for two years, oh, and tell me about uncertainty. That weather, my goodness, you never know whether you will be able to go to a picnic or not. So a good thing is to team up with your rheumatologist and the rheumatology team. And, they really are with you, they are accompany you. And they have the door open for whenever you have you think you have a flare.

I mean. You can stay alone a long time and help you cope.

[00:09:29] Cheryl Crow: I totally agree, and I think even just saying the words out loud, like, we don’t know for sure in rheumatology. Like when my doctor told me that it, she’s like, it’s not like some other areas where we can say a hundred percent. And saying it out loud help me realize, okay, it’s not like she’s holding a secret from me or something. ”Cause I think sometimes patients feel that way, like they just don’t wanna tell me or something.

But it’s that we’re on the same team. We’re partnering and I’m keeping her in the loop with what’s going on with me. So I’m lucky that I’ve had the same rheumatologist for 22 years.

Back to our, we always make a list here. You’ve already answered this implicitly, but Eileen and I talk to a lot of patients and a lot of people feel guilt if they don’t reach remission. I don’t actually like the word “achieve” remission, ’cause it’s not really an achievement if it’s partly luck, right? But do you agree or disagree that people who don’t reach remission just didn’t try hard enough or didn’t do everything right.

[00:10:25] Dr Loreto Carmona: Okay. I hate this thing about guilt, I mean, you cannot be guilty for having a disease or for not being in remission. You can do things to improve your chances of being in remission, but that’s responsibility, not guilt, okay?

So, if you are responsible for your disease, if you are responsible for going to your appointments, if you’re responsible for achieving a good communication, yeah, you’re responsible for that.

But it’s not your fault. Not at all. I mean, if you’re doing all your things, I mean really.

[00:11:00] Cheryl Crow: Yeah, that, that makes a lot of sense.

[00:11:03] Eileen Davidson: I completely agree with you. I hate the term when you feel or just feeling guilty that I have the disease that I caused it.

And it is even interesting ’cause some people will talk to you like, what did you do to cause this? Like X, Y, Z person I know that managed to achieve, you know, cured their disease with diet kind of thing. So yeah, that, that’s really good to know that we definitely didn’t cause this to ourselves.

One of the most important things that patients can do is improving their communication with their physicians, especially when it comes to remission. What are some impactful questions that patients can ask their doctors about possibly achieving remission?

[00:11:48] Dr Loreto Carmona: Yeah, perhaps, of course, to, to know how their bloods are going, their blood tests to know what are the options of treatment, whether there are still options of treatment, and of course what can they do for themselves. You mentioned diet, of course you can follow an anti-inflammatory diet as much as you can, but basically it’s avoiding sugar as much as you can and avoid things that you know are not good.

Yeah. Ultrapro foods and things like that you can do that. You can also do exercise, so I mean, you can do things. Very importantly, your rheumatologist is not going to know much about diets, or exercise, okay? So I will ask your rheumatologist whether he or she can pinpoint somebody or some resources to help you with that.

For instance, patients associations, they have great resources for that because we really don’t, are not good at these things.

[00:12:47] Cheryl Crow: Yeah. And luckily we’ve covered that on a couple other episodes too. ’cause there’s some great data out there for nutrition and other lifestyle things like exercise and then there’s some kind of a lot of myths and misconceptions. So we tried to combat those, so thank you.

This is another myth versus fact before we start wrapping up a little bit you know. I’ve heard that, oh, I know this is a fact, but myth versus fact are more people in remission from RA today than let’s say 30 years ago in 1995.

[00:13:23] Dr Loreto Carmona: Yes. Yes. Yeah. When I started rheumatology as a resident, most of the patients were not in remission. They were not in remission. I mean, right now, you know, what is happening is that now they, some residents do not believe that patient has rheumatoid arthritis because they don’t see the signs that we used to see in the past. So yes, it has been a complete game changer. Game changer. And

[00:13:52] Cheryl Crow: It’s the medications, right?

[00:13:54] Dr Loreto Carmona: That’s the game changer, yeah, it is. It is. The medication and the approach, like before we were going one step after the other, now we go really fast, and then try our best and then change fast. So the approach has changed completely. We have many more drugs. So yeah, it has completely changed now.

It’s a good time, you know, to have rheumatoid arthritis. Yes.

[00:14:14] Cheryl Crow: I agree. I mean, I got so lucky being diagnosed in 2003 and I was put on aggressive, early aggressive treatment right away, and I went into complete medicated remission for six years.

The only problem with that was that I didn’t understand that it wouldn’t last forever. So I just thought that I figured out RA, I have my plan, I just take the same medication for the next 60 years.

And then when my body changed and I wasn’t in remission anymore, then that was when I had to actually understand the disease more. But anyway I think that history is important. Eileen has a historical story too.

[00:14:50] Eileen Davidson: Yeah, I do. So I have an aunt, or had an aunt who was diagnosed with rheumatoid arthritis about 40 years prior to me, and I never saw her walk more than a few steps.

She was mostly in a wheelchair. She had the deformed hands and rheumatoid arthritis devastated her life. She was treated before the times of DMARDs or biologics. In fact, when they used gold to treat rheumatoid arthritis.

Or just had you kind of lay rest all the time. They told you don’t exercise and you were kind of just sort of forgotten about, kind of left there. And now having been involved in, with research with Arthritis Research Canada and going to all the different rheumatology conferences, it’s really interesting to learn how they are actually starting to see less and less deformed hands, less joint replacements, less wheelchair use.

Unfortunately, this isn’t for everyone and there’s many different reasons to use a wheelchair or a mobility devices. It could even be side effect related. So I think it’s just something really to kind of highlight how far medication advances have come in the last particularly 25, 30 years. And unfortunately my aunt passed away the same week I was diagnosed, from heart disease, which was a complication of her untreated rheumatoid arthritis. So it, that’s actually one of the reasons why I’m an advocate today.

[00:16:09] Cheryl Crow: That’s amazing. Thank you Eileen for sharing that story.

And I wanted to know Dr. Carmona, is there as we start kind of wrapping up a little bit, in one sentence, what is the most important takeaway you’d like someone to take from this episode?

[00:16:28] Dr Loreto Carmona: I would say that remission is possible if we are all in the same team, and I will stop there.

I think it’s possible if we’re in the same team. Yeah.

[00:16:39] Cheryl Crow: That’s wonderful. Awesome.

[00:16:41] Eileen Davidson: I agree. I say that it takes a team to treat rheumatoid arthritis, and your team involves rheumatologists, it involves social workers, psychologists, psychiatrists, occupational therapists, physiotherapists. Yeah. I’m sure there’s others, you know, with the, well, the family.

Yeah. Your social support for sure. It definitely does. Now, if people want to learn more about remission, where do you recommend they go?

[00:17:07] Dr Loreto Carmona: I, I mean, we have now the Global Alliance for remission. I think that’s a good place to go. So you can the Global Remission Alliance, I think is global remission.com.org.

Yes. It’s so you can, yeah. So you can probably go there because we have a lot of things. It’s, it is only, it’s remission not only in rheumatoid arthritis, but in, in other diseases, autoimmune diseases. Yeah. We, that’s

[00:17:31] Eileen Davidson: helpful. We cover, yeah, we cover rheumatic diseases. What today’s on rheumatoid arthritis for the campaign that I’m, we’re kind of involved in with here, but yes, remission, it we’re talking about with rheumatoid arthritis can be applicable to many other rheumatic diseases.

[00:17:45] Cheryl Crow: Yeah, that’s super helpful. And what, if people wants to follow up specifically with you, do you have a social media handle or LinkedIn you can share?

[00:17:55] Dr Loreto Carmona: Yes, of course I have LinkedIn, they can find me easily.

Loreto Carmona. And then I also have blue sky now. Nice. Yeah.

[00:18:04] Cheryl Crow: Awesome. I’ll have to find you there too if I haven’t already.

[00:18:09] Dr Loreto Carmona: Yes. I usually take questions, so I’m okay with that.

[00:18:13] Eileen Davidson: Well, thank you. That’s good to know. Alright, well thank you again for listening to another episode of Rheumer has

[00:18:19] Cheryl Crow: it, don’t forget to check out the full show notes on the Arthritis Life website, which is@myarthritislife.net for a full transcript plus a video of our conversations.

[00:18:32] Eileen Davidson: Thank you so much for being here, Loreto. It has been an absolute pleasure getting to speak to you again, and thank you for doing such great work in the rheumatology community. We would also like to hear what you like, think of this episode, shoot us an email or comment on our social media accounts.

[00:18:48] Cheryl Crow: Awesome. Thanks again and bye-bye for now. Thank you.

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