What is rheumatoid arthritis?
Rheumatoid arthritis (RA) is a condition that is characterized by swelling in joints as a result of the immune system attacking the tissue of those joints. The following symptoms are common in RA:
- Swelling of the hands, feet, or ankles
- Joint pain, especially in the low back
- Shortness of breath
- Numbness or pain in your hands. This is related to carpal tunnel syndrome of pregnancy
Notice that these symptoms also occur frequently during pregnancy. This is something that can make it difficult to distinguish between flare-up of RA and simply a response to pregnancy.
How common is RA during pregnancy?
RA strikes about 1 percent of adults, but women are affected more often than men. Since the disease often appears by the time that a woman has reached childbearing age, it is quite common for RA to occur during pregnancy.
How is RA during pregnancy diagnosed?
As noted above the clinical effects of RA, such as the symptoms that you experience can be difficult to distinguish from those of pregnancy. However, RA can be diagnosed through a combination of imaging (X-rays of the affected joints) and several laboratory tests performed on samples of your blood.
Does RA cause problems during pregnancy?
About 75 percent of pregnant women with RA actually notice their symptoms improve during pregnancy, but this comes at a cost as most of these women experience flare-up of the disease within 3 months of delivery. Those women who do experience flare-up of RA during pregnancy tend to have longer stays in the hospital, plus they are more likely to require cesarean section (surgical birth).
Does RA during pregnancy cause problems for the baby?
In women who experience RA flare-ups during pregnancy, the disease itself increases the risk of what doctors call fetal loss, a term that includes spontaneous abortions, late miscarriages, and stillborn births. Usually, these undesirable outcomes happen in mothers whose immune systems produce what are called anti-phospholipid antibodies. However, in babies that survive, it is also possible for RA in the mother to cause intrauterine growth retardation, resulting in health problems after birth.
What to consider about taking medications when you are pregnant or breastfeeding:
- The risks to yourself and your baby if you do not treat the rheumatoid arthritis. These can be significant
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat RA during pregnancy?
Virtually all of the medications that are most effective in combating both the pain of RA, and the inflammation that worsens the disease, are rather unhealthy to the developing baby, but certain medications are particularly dangerous. Examples of the latter category include methotrexate, leflunomide, and COX inhibitors, and there also are categories of RA medications that are thought to be dangerous but for which research has been limited. This includes biological agents, such as Ritoximab and other drugs that end with mab. Narcotic agents (opioids) also are used in RA, and these can be harmful to the baby too. On the other hand, there are some medications, such as azathioprine and low-dose aspirin that are though to be only slightly risky in pregnant women with RA. There also are drugs called corticosteroids, which can be administered for a time to combat a flare-up, and then tapered off.
Who should NOT stop taking medication for RA during pregnancy?
This is an extremely personal decision for the pregnant woman and her doctors. Every drug used in RA has benefits and risks, but since there are so many such drugs often it is possible to replace one drug with another. On the other hand, since most women with RA can expect to improve during pregnancy, the solution is often to plan the pregnancy and stop drug treatment prior to conception. Then, if it turns out that you do have a flare-up in the midst of pregnancy, a drug can be chosen so as to mitigate the flare-up while keeping the risk to the developing baby at a minimum.
What should I know about choosing a medication for my RA during pregnancy?
As noted in the previous section, there is a reasonable chance that youll get lucky and not require medication, or at least not strong medication, against RA during pregnancy. But, if needed, a drug can be chosen so as to mitigate the flare-up while keeping the risk to the developing baby at a minimum.
You may find Pregistrys expert reports about the individual medications used to treat RA here. Additional information can also be found in the sources listed at the end of this report.
What should I know about taking a medication for my RA while I am breastfeeding?
The various drugs that are effective against RA vary both in their tendency to enter breast milk and in their potential harm to the nursing baby if they do get into the milk. You should keep in mind that although RA tends to subside during pregnancy it also tends to flare-up soon after delivery. In order to encourage breastfeeding, doctors have taken seriously the pharmacokinetics of various agents, meaning the science of how quickly the drugs move through the mothers system. For certain drugs, this has led to ideas on how to burn the candle at both ends in a sense. With the steroid prednisolone for instance, it is known that it builds up in breast milk mostly during the first four hours after a dose is given. Consequently, some doctors who give this agent for RA after delivery will suggest that the patient wait four hours after receiving each dose, then pump out her milk and discard it, then wait for new milk to accumulate and nurse the infant from that new milk.
Some options for what to do about that missed feeding include: pumping earlier in the day and saving the milk to feed in place of the discarded milk, feeding formula for that one meal a day, or simply using formula for all feedings. A lactation consultant can help you if you would like to keep breastfeeding. It is true that many studies suggest that there are benefits to breastfeeding both to the child and the mother, its also true that in most such studies it has been difficult to separate the true benefits of breastfeeding from various socioeconomic factors that also relate to whether women chose breastfeeding over formula.
What alternative therapies besides medications can I use to treat my RA during pregnancy?
Several treatments are under investigation as to whether they can be helpful in RA, and that are used sometimes as a secondary treatment, in combination with medications. These include occupational therapy, foot orthotics (special shoe inserts designed to support the foot), finger splints, wrist splints, and various diets. Cognitive behavioral treatment also has been under investigation. So far, evidence that such treatments are much help against RA is rather skimpy.
What can I do for myself and my baby when I have RA during pregnancy?
Stay in close contact both with your rheumatologist and your obstetrician. Work with your doctors to choose a treatment strategy that minimizes risks for the fetus, but also protects both you and the fetus by mitigating flare-ups of RA.
Resources for RA in pregnancy:
For more information about rheumatoid arthritis during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or check the following links:
- Arthritis Foundation: Rheumatoid Arthritis and Pregnancy
- American College of Rheumatology: Pregnancy and Rheumatic Disease