Diseases and Disorders

Rheumatoid Arthritis in Pregnancy

RA is one of the most common rheumatic diseases affecting women of childbearing age. Learn what you should know about rheumatoid arthritis in pregnancy.

RA is a chronic inflammatory condition that occurs when the body’s immune system attacks its own tissues. During pregnancy, RA can affect the mother and her baby. Read on to learn more about RA in pregnancy. You’ll also find information on symptoms, treatment options, and complications.

Rheumatoid Arthritis in Pregnancy

Rheumatoid arthritis (RA) is a chronic autoimmune disease, with prevalence being three times higher in women than men. It is a systemic autoimmune disease characterised by inflammatory synovitis affecting multiple joints. The inflammation because of RA leads to progressive joint destruction and severe disability. It also leads to increased mortality. However, if treated with Disease changing Anti-inflammatory drugs (DMARDS) remission can be achieved.

A woman has to undergo many phases in life, including pregnancy. A woman with RA may have to follow some instructions during pregnancy. With advances in the management of RA, the disease can be better controlled and a safer outcome of pregnancy is possible. However, treating RA during pregnancy can be challenging as most of the disease-change antirheumatic drugs (DMARDS) cannot be used safely considering their adverse effects on pregnancy

Rheumatoid Arthritis and Pregnancy

Getting reproductive history is important in all women diagnosed with RA. Patient should be educated about risks and possibility of adverse outcomes associated with RA or because of medications.

Rheumatoid arthritis and fertility

About, one third of females with RA have trouble conceiving a child. They are more likely to have undergone treatment for fertility than women without RA. Data reveal that women with RA bear fewer children compared to women without RA. Pregnancy can influence autoimmune rheumatic disease like RA. 

Rheumatoid arthritis activity and pregnancy

Disease activity of RA often improves during pregnancy; reverting in a partial improvement in clinical symptoms and sometimes even complete remission, but the improvement can be short-lived and the disease usually relapses after delivery. The studies have shown that pregnancy influenced the disease course more in patients who had moderate to high disease activity at the time of conception. 

The disease often shows flare during the post-partum period. This trend is observed even during subsequent pregnancies. 

Management of Rheumatoid Arthritis and Pregnancy

Getting reproductive history is important in all women diagnosed with RA. Patient should be educated about risks and possibility of adverse outcomes associated with RA or because of medications. 

It is imperative to counsel them for contraception while on DMARDs and, while doing so, a patient’s background should be considered.

Male patient with RA on DMARDs

Patients on methotrexate should wait for at least 3 months after cessation of the drug before attempting conception. The patient should preferably have low disease activity or be in remission. 

Post conception management

If the pregnancy is unplanned while the patient is on RA therapy, a risk of each medication on mother and foetus should be explained.

Immediate discontinuation of drug like methotrexate and leflunomide should be done. With women receiving leflunomide and conceiving unintentionally, the pregnancy should be ended. If the patient desires to continue the pregnancy, she should undergo a washout procedure to facilitate drug excretion. Hydroxychloroquine and sulfasalazine can be continued during pregnancy.

Rheumatologist’s Advises

  1. The other DMARDS should be stopped for at least three months before planning for pregnancy and Leflunomide should be stopped for 2 years before pregnancy
  2. Non-steroidal anti-inflammatory drugs should also be stopped during pregnancy

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Expert Advice Before You Plan Pregnancy

Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammation of the joints. In pregnancy, RA may cause joint pain, swelling, stiffness, fatigue, fever, and weight gain. Learn more about RA during pregnancy here.

5 key points to keep in mind:

  1. Pregnancy should be planned only when RA is stable or inactive 
  2. The optimal therapeutic strategy should be chosen, balancing efficacy and adverse effects of medications
  3. Detailed patient counselling should be done prior to planning pregnancy
  4. Leflunomide should not be given to patient of childbearing age
  5. A good control of RA disease activity during antenatal period is vital for positive maternal and foetal outcomes,
Conclusion

Patient should be educated about risks and possibility of adverse outcomes associated with RA or because of medications, facts and recommendations by Dr. Jyotsna Oak, Physician and Rheumatologist, Kokilaben Dhirubhai Ambani Hospital, Mumbai

Read About: Rheumatoid Arthritis

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