Many rheumatoid patients, after a period of regular treatment, are moved to stop the medication – my joints do not hurt or swell now, and the medication always feels like it will have side effects, so can I stop it? Doctors here want to say: the drug can be reduced, but should not be completely stopped. This is because most patients who discontinue all rheumatoid arthritis treatment medications experience a relapse of the disease after a period of time. Due to the characteristics of the disease, many patients do not experience joint swelling and pain immediately after stopping anti-rheumatic drugs, but rather after a delay (e.g., 3 months), which “confuses” many patients and gives them the illusion that “it’s good to stop”. For example, in this experiment, we can see that whether using traditional anti-rheumatic drugs or biologics, after achieving remission, if the drug is stopped directly, 70% of patients will have a relapse within six months, and if the timeline is stretched to one year, two years or even longer, then this number will be further increased. Relapse, you need to use drugs again, and often than before the discontinuation of the dose, more kinds of drugs, the result is not good control of the disease, but also not less medicine, it is not cost-effective. Therefore, we tend to use the strategy of “drug reduction and non-stop” – in the case of patients with good control of the disease, the maximum amount of drugs, taking into account the effectiveness, safety and economy. Many patients may ask, “I am currently taking several medications, which one should I stop first? In fact, this is very delicate. The first situation: the combination of traditional slow-acting drugs, biologics, hormones and painkillers In general, when several of these drugs are used in combination, we generally follow the order of reducing hormones/painkillers first, then biologics, and finally traditional slow-acting drugs to gradually reduce the dosage. The order of drug tapering is generally done according to the following table: Take a patient on prednisone (hormone) + tolimumab (biologic) + methotrexate (traditional slow-acting drug) as an example, after a period of use, the patient’s joints are free of swelling and pain, his blood sedimentation has dropped to normal, and his condition has resolved. At this point, the doctor began to want to reduce the patient’s medication. So how do you reduce it? We first taper the hormone, slowly reducing the dosage until it is completely discontinued. Then we start to taper tolimumab: for example, if the patient is still in remission after a period of time, we will taper to 3 months, and if the patient is still in remission, we will stop the biologics and let the patient take only the traditional slow-acting medication. However, if the reduction process does not go well and the patient develops joint swelling and pain again, or is accompanied by increased blood sedimentation, we do not continue the reduction, or we increase the dose of the current drug appropriately, such as raising tolimumab from once every 3 months to once every 2 months, so that the disease is under control and the minimum dose of the drug is maintained. The order of drug reductions should not generally be reversed; for example, it would be incorrect to reduce biologics first when hormones are still being taken. This is because hormones, anti-inflammatory and analgesic drugs, generally can only control symptoms, but can not stop joint destruction, therefore, placed in the first position to reduce the dose; biological agents: can control symptoms, but also stop joint destruction, but relatively expensive, placed in the second position to reduce the dose; traditional slow-acting drugs can prevent joint destruction, but the price is cheap, therefore, the last to reduce the dose. The second situation: using only traditional slow-acting drugs For example, if a patient is treated with only methotrexate, leflunomide, or salazosulfapyridine, we will gradually reduce the type of drugs or the dosage of drugs after the disease is completely controlled. However, the specifics will vary depending on the patient’s condition. However, in the spirit of pharmacoeconomics, and evidence-based medicine, we generally give priority to keeping methotrexate for the final reduction. Scenario 3: Biologics only In most cases, biologics need to be used in combination with traditional slow-acting agents such as methotrexate, because most biologics in combination with methotrexate can enhance efficacy and reduce the production of antibodies. However, some patients are unable to tolerate traditional anti-rheumatic drugs such as methotrexate because of adverse effects such as reduced white blood cells and liver function impairment, and need to use biologics alone to control rheumatoid arthritis. In such cases, rheumatologists recommend tolimumab (Yamiro) or small-molecule targeted drugs in preference to control the disease. In the case of tolimumab (Yamiro), for example, it targets IL-6 factor (interleukin 6), an important pro-inflammatory factor in the development of rheumatoid. IL-6 has multiple roles, not only in mediating the development of rheumatoid arthritis, but also in promoting the production of antibodies. By “targeting” IL-6, tolimumab (Yamiro) exerts a powerful anti-inflammatory effect on the one hand, and prevents the production of antibodies on the other, making it less likely to fail secondary to long-term use and less likely to compromise its efficacy, making it the first choice for biologic monotherapy. For this type of rheumatoid patients using only biologics, after the disease is stabilized, we will gradually reduce the drug by reducing the dose administered, or extending the dosing interval. Based on convenience considerations, we usually extend the dosing interval to allow patients to get their disease under control while providing the best possible convenience. Finally, we wish every rheumatoid patient to meet the standard treatment and enjoy a good life without swelling and pain.