Rheumatoid arthritis (RA) affects 1 percent of adults, with women suffering more than men. Many women with RA have a childbearing age, which emphasizes the importance of careful family planning, especially in patients taking medications or who have active disease. In this article, we will consider rheumatoid arthritis and pregnancy.

In many women with RA, the disease improves significantly during pregnancy. However, some women have outbreaks and remain active during pregnancy. Thus, it is often necessary to change or change the treatment of RA during pregnancy in order to control outbreaks while reducing the risks of treating RA in the developing fetus.

Changes in Rheumatoid Arthritis During Pregnancy

Many changes in the immune system usually occur during pregnancy. These changes allow the fetus to grow and develop. Some of these changes improve symptoms of rheumatoid arthritis (RA) during pregnancy.

Disease activity – about 50-60% of women with RA report an improvement in the signs and symptoms of rheumatoid arthritis during pregnancy. A decrease in the activity of the disease usually begins in the first trimester and lasts until birth. Unfortunately, no one can predict which patients will feel better during pregnancy.

Rheumatoid arthritis and pregnancy – sometimes, it is difficult to distinguish between the general discomfort of pregnancy and the symptoms of RA. Pregnancy discomforts similar to rheumatoid arthritis include the following:

  • Fatigue.
  • Swelling of the hands, feet, or ankles.
  • Joint pain, especially in the lower back.
  • Dyspnea.
  • Numbness or pain in one or both hands (caused by carpal tunnel syndrome during pregnancy).

Pregnancy results. Most reports show that women who have RA do not have an increase in stillbirth or miscarriage. However, some medications, especially high doses of steroids, may increase the risk of having a smaller than usual baby and may increase the risk of premature rupture of membranes.

Rheumatoid Arthritis and Pregnancy

Rheumatoid Arthritis and Pregnancy – Care Before Pregnancy

Women with rheumatoid arthritis (RA) should discuss their desire to get pregnant with an arthritis specialist (rheumatologist) and obstetrician before trying to get pregnant.

General recommendations that apply to all women who are considering pregnancy can be found separately. Besides:

  • If a woman is taking prescription or over-the-counter medicines for RA, they should be reviewed with the help of a doctor. Some drugs are safe during pregnancy, while others are not. In some cases, an alternative drug may be replaced with an unsafe drug.
  • Women taking methotrexate should stop it at least one month before trying to get pregnant, although the manufacturer suggests stopping this treatment with three full menstrual cycles before attempting pregnancy. This waiting period is necessary in order to allow the effect of methotrexate on the body to pass in such a way that it is safe so that it is safe to become pregnant.
  • Women taking leflunomide should stop it for at least two years before trying to conceive, if not using a course of treatment, to exclude the drug from the body. Therefore, women of childbearing potential should discuss the use of this drug with an arthritis specialist.

Women with long-term medical problems often have concerns about how their health will depend on pregnancy and parenting. Women with rheumatoid arthritis often have an improvement in symptoms of pain and fatigue during pregnancy, but after that, they may have worsened these problems after giving birth. Therefore, it is important to be prepared for the changes that a new baby can bring, including intermittent sleep, fatigue, stress, and anxiety. Close contact with an obstetrician and rheumatologist, as well as support from family and friends can help alleviate additional problems associated with pregnancy and raising a child.  Medication for rheumatoid arthritis.

Treating Rheumatoid Arthritis During Pregnancy

Rheumatoid arthritis and pregnancy – some women have outbreaks during pregnancy and require treatment. However, some medications used to treat RA can be harmful to the fetus. The benefits of any medicine should be balanced with the potential risk.

Pregnancy care for women with RA is usually divided between a rheumatologist and an obstetrician.

Medications during pregnancy – the safety of RA drugs during pregnancy and their effects on the fetus are not always clearly known. For each patient, the decision about which drugs to use will depend on their response to treatment, the activity of their disease, their general medical status, and other individual factors.

Methotrexate and leflunomide should be avoided completely during pregnancy because of the significant risk of fetal damage. If a woman takes one of these medicines during pregnancy, she should speak with a doctor immediately. Other medicines, such as non-steroidal anti-inflammatory drugs (NSAIDs), can be safely taken during one part of pregnancy, but not the other.

For some patients, the benefits of the drug in controlling the disease and in maintaining function may outweigh the possible risks to the mother or fetus. The use of any drug for arthritis during pregnancy is a matter that the patient and her rheumatologist should discuss in order to avoid potentially dangerous drugs, and the individual risks and benefits of any other drug should be carefully weighed. 

Rheumatoid arthritis after childbirth

Approximately 90 percent of women with rheumatoid arthritis (RA) experience an outbreak in the postpartum period, usually during the first three months and especially after the woman’s first pregnancy. Many experts recommend resuming medication for rheumatoid arthritis in the first few weeks after birth.

Breastfeeding and rheumatoid arthritis activity. The postpartum period is a common time when women with RA have an outbreak of the disease, so it is difficult to see if breastfeeding increases this risk. However, there are many benefits of breastfeeding for both women and their children. For these reasons, women with RA who want to breast-feed are advised to do so.

Medicines and breastfeeding. Many of the same restrictions on the use of drugs during pregnancy also apply to nursing mothers:

  • Shorter acting non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be used in lactating women. 
  • A low dose of aspirin (81 mg per day) is compatible with breastfeeding, but higher doses should be avoided.
  • Prednisone can be taken in small doses. At doses greater than 20 mg per day, it is recommended to pump out and discard breast milk, which is produced during the first four hours after administration.
  • Methotrexate and leflunomide should be avoided during breastfeeding.
  • Azathioprine is compatible with breastfeeding.
  • The data are ambiguous regarding cyclosporine, therefore this medication should be avoided if there is no alternative.
  • Tumor necrosis factor (TNF) inhibitors, such as etanercept, infliximab, or adalimumab, are compatible with breastfeeding.

Birth control and rheumatoid arthritis. After giving birth, before resuming sexual intercourse, it is important to start thinking about birth control. There are a number of birth control options, most of which are safe and effective for women with RA. In most cases, rheumatoid arthritis and pregnancy should not affect which method of birth control a woman chooses.Life with rheumatoid arthritis.


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