What Is a Relapsing-Remitting Disorder?

Characterists, Types, and Coping with Relapsing-Remitting Disorders

Man sitting on bed with backache and headache
What are the types of relapsing-remitting disease, and how can you cope?. Paul Bradbury/OJO Images/Getty Images

Your doctor may have mentioned that the condition you've been diagnosed with—such as multiple sclerosis, rheumatoid arthritis, or other autoimmune disease—has a relapsing and remitting pattern. What does that mean, and what should you know as you seek out a support system to help you cope with your condition?

Definition: Relapsing-Remitting Disorders

A relapsing-remitting disorder means the symptoms are at times worse (relapse) and other times are improved or gone (remitting).

During a chronic pain relapse, pain would be present partially or completely. During a remission, however, pain would subside and require little, if any, treatment.

Relapsing and remitting conditions may follow certain patterns, or they may stop and start with seemingly no rhyme or reason. Some remissions are exacerbated by additional injuries or other factors.

Because disease symptoms come and go in relapsing-remitting disorders, sufferers can often be lulled into a false belief that they are cured of their illness, when, in fact, they are only in remission. 

Three Types of Relapsing-Remitting Diseases

There are actually several different types of relapsing-remitting diseases which can be illustrated with three conditions in particular.

Relapsing-Remitting Multiple Sclerosis (RRMS). Roughly 85 percent of people with multiple sclerosis initially have what is considered relapsing-remitting disease, because they often have both active phases and inactive phases.

Commonly known as Relapsing-Remitting Multiple Sclerosis (RRMS), this autoimmune disease often has worsening inflammation attacks that impact neurologic function. The relapses are often followed by remission periods, during which time symptoms improve. Common symptoms of RRMS are vision problems, bowel and bladder problems, fatigue, numbness, stiffness, and problems with memory or information processing.

Eventually, many of these people will evolve to having secondarily progressive multiple sclerosis in which there is a progression of symptoms, but fewer or no relapses.

Rheumatoid Arthritis (RA) is another autoimmune disease that often is classified as a relapsing-remitting disorder. Rheumatoid arthritis, which causes the immune system to attack parts of the body, affects tissue in the joints. These attacks cause episodes of inflammation that can result in stiffness and severe pain, and can cause long-term and progressive damage of the joints. Inflammation symptoms of RA can include fever, sweats, weight loss and fatigue. There are various classes of medications that can put the disease into remission for extended periods of time, depending on the severity of the disease.

Systemic Lupus Erythematosus (SLE), an autoimmune disease, also often follows a remitting and relapsing course. Systemic lupus erythematosis is more common in women than men and can strike at any age. Races most affected by this disease are African Americans and Asians.

Episodic symptoms of lupus include severe fatigue, joint pain, swelling, mouth sores, hair loss, fever, general discomfort, sensitivity to sunlight, skin rash and swollen lymph nodes. Some people with SLE also develop arthritis, and the joints of the fingers, hands, wrists, and knees are often affected. Other SLE symptoms depend on the part of the body SLE attacks, for example, the heart, the lungs, the skin, the kidneys, or other organs. While there is no cure for SLE, the goal is to control the symptoms that can come in a remitting and relapsing pattern.

Coping with Relapses and Remissions

Coping with a relapsing and remitting disease is very difficult. We are creatures of habit and can adjust fairly well to a condition which occurs but follows a predictable pattern. The element of surprise, however, in a relapsing-remitting condition catches you off-balance and unprepared, just as other surprises in our lives, good or bad. When this happens recurrently, you may begin to distrust your body, a bad feeling.

In addition to feeling off-balance, these relapses and remissions can make you angry—and for good reason. These conditions don't follow the rules and they don't play fair. It can be frustrating, especially, when your symptoms recur when you're doing everything right, or remit when you're doing everything wrong. Since anger with multiple sclerosis can be caused by changes in the brain as well, the relapsing and remitting aspect of the disease can—to use an old adage—add fuel to the fire, Autoimmune diseases can produce in your mind a deep feeling of insecurity. The only thing that doesn't appear to change is that change in inevitable.

Coping with Relapses

Even when you expect to have relapses—when you've been told and read that they do occur—it can still be a shock when your symptoms come back. This can be even harder if your symptoms have been in remission for some time.

Some people find it even more difficult to cope with a relapse of symptoms than with the initial diagnosis of their condition. It's similar for people who have an initial diagnosis of cancer, and later have a recurrence. When you are first diagnosed you are often surrounded by family and friends. In comparison, when you have a relapse, your news is "old news" and doesn't often generate the same rush to help.

In addition, a relapse is a slap-in-the-face reminder that you really do have a disease. If you are diagnosed and your symptoms abate on their own or with treatment, your mind can easily be fooled that perhaps you are the exception. Unlike others, your condition won't recur, or maybe you were even given the wrong diagnosis in the first place. A relapse is a not-so-subtle reminder that you have a disease and it is not going to just go away.

In a way, a relapsing disease is similar to bullying behavior in people, though in this case the bully is a disease. A bully may lead you to think that you are no longer a target, and when he has regained your trust, hits you even harder, knocking you down. Such is what it can feel like when one of these conditions relapse.

Coping with Remissions

What might surprise some people is that it can be as difficult to cope with remissions in a disease as with relapses. Have you ever caught yourself feeling anxious, wondering when the next "foot would drop?" A temporary (or longer) hiatus from a disease sometimes brings with it energy enough to really think about your disease. When you are coping with a relapse, your are focusing on getting through that stage of the process. But when your condition remits, you're left with time to think: "What is this disease doing to my life?"

You may think that finding support or taking part in a support group would be most important when you are in the throws of a relapse, but it can be just as important to seek support when you are in remission. It is then that many of the questions come to mind—the questions that make you take stock of your life. And, it is often those who have coped with relapses and remissions themselves who can best understand.

Sources:

Firth, N. Effectiveness of Psychologically Focused Group Interventions for Multiple Sclerosis: A Review of the Experimental Literature. Journal of Health Psychology. 2014. 19(6):789-801.

Kalb, R. The Emotional and Psychological Impact of Multiple Sclerosis Relapses. Journal of Neurological Sciences. 2007. 15:256 Suppl 1:S29-33.

Solomon, A., and J. Bernat. A Review of the Ethics of the Use of Placebo in Clinical Trials for Relapsing-Remitting Multiple Sclerosis Therapeutics. Multiple Sclerosis Related Disorders. 2016. 7:109-12.

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