If you’re a woman with rheumatoid arthritis and your biological clock is ticking, the good news is that you should be able to start a family, provided you understand how RA may affect your pregnancy and take a few precautions first.
[See: 7 Surprising Things That Age You.]
Rheumatoid arthritis is a chronic inflammatory disease that affects multiple organ systems throughout the body. The most important factor affecting whether you will have a problem-free pregnancy and a healthy baby is your level of inflammation and disease activity.
According to the Arthritis Foundation, there is no specific test to measure disease activity in RA, so rheumatologists use a combination of factors to come up with an overall score. These include assessing a person’s level of pain and the degree of difficulty performing various routine tasks, which is determined using a patient questionnaire; counting the number of swollen, tender joints; and obtaining blood tests that evaluate the erythrocyte sedimentation rate and the C-reactive protein level — two important markers of systemic inflammation.
“Patients with well-controlled disease have outcomes similar to other women [who do not have RA] in the same age groups,” says Dr. Steven Eyanson, a rheumatologist in Cedar Rapids, Iowa.
“The patient should plan with her rheumatologist, obstetrician [and] other caregivers to ensure good control of her RA well before she plans to get pregnant, or consider delaying conception until that goal is met,” Eyanson advises.
“Increased disease activity and poor control, especially during the third trimester, can lead to babies with low birth weights, preterm delivery and possibly spontaneous abortion,” he says. “Patients with active disease should be managed by both a rheumatologist and a maternal-fetal medicine specialist.”
A regimen of powerful medications is vital to keep inflammation and disease activity in check. However, some of these drugs can have harmful effects on a developing fetus, as can the inflammation itself.
“There is a need to avoid certain disease-modifying anti-rheumatic drugs, such as methotrexate and leflunomide,” says Dr. Elena Schiopu, a rheumatologist and associate professor of medicine at the University of Michigan School of Medicine in Ann Arbor. “If there are any chances of a planned or unplanned pregnancy, these medications should be discussed and avoided.”
“The DMARDs sulfasalazine, azathioprine and hydroxychloroquine seem to be safe for mother and baby,” Schiopu continues, and “the tumor necrosis factor-alpha blocker certolizumab pegol [Cimzia], which has minimal transfer to the placenta, appears to be safe during pregnancy and lactation,” she notes. “However, data on other biologics such as anakinra, abatacept, tocilizumab and tofacitinib are lacking.”
“It is important to stress that any medications used by pregnant RA patients are best tailored by the treating physician for optimal outcomes for both the mother and baby,” says Dr. Margaret Tsai, a rheumatologist with the Cleveland Clinic in Ohio.
[See: 12 ‘Unhealthy’ Foods With Health Benefits.]
Eyanson also emphasizes the importance of discontinuing any potentially harmful drugs several months before pregnancy, because they can stay in the system for varying periods after they are stopped.
According to the Arthritis Foundation, women with RA do have fewer children than their RA-free counterparts, but this is probably the result of a choice to limit family size rather than impaired ability to either conceive or carry a baby to term.
“Patients with RA have smaller families for a number of reasons, which include patient choice, medication use during the usual time of family planning and [decreased] fertility related to disease activity,” Eyanson says, noting that “the relative importance of these factors is difficult to determine.”
One interesting aspect of pregnancy and RA is that the majority of women actually experience lower levels of active disease while they are pregnant.
“More than 79 percent of [pregnant] women experience slight improvement in their RA by the second trimester, and the severity of RA pre-pregnancy seems to correlate with the degree of improvement — the milder the RA, the better the improvement,” Tsai says.
Schiopu says the improvement in active disease may be the result of alterations in the proteins, called cytokines, that are responsible for RA’s inflammation, or it may reflect the change in hormones that occurs during pregnancy.
“It is evident that the remission in pregnant RA patients is due to a decline in pro-inflammatory [processes], but no single theory has been proven to be responsible for the remission,” Schiopu says.
Disease remission tends to reverse once patients give birth, however.
[See: 10 Weird Mind and Body Changes That Are Totally Normal During Pregnancy.]
“Approximately 90 percent of pregnant RA patients experience a disease flare [after giving birth], usually within the first three months” Eyanson says.
Staying in close touch with both the rheumatologist and the obstetrician, including a high-risk obstetrician, if needed, is important before, during and after pregnancy, Schiopu notes. “Tracking the disease activity and fetal development are also very important,” she concludes.
More from U.S. News
10 Weird Mind and Body Changes That Are Totally Normal During Pregnancy
12 ‘Unhealthy’ Foods With Health Benefits
7 Surprising Things That Age You
You Can Have a Safe and Successful Pregnancy if You Have Rheumatoid Arthritis originally appeared on usnews.com
