Rhumitoid arthritis and pregnancy - treatment, medication

Pregnancy has been noted to have an improving effect on RA - Rheumatoid Arthritis (rheumatory, rhumitoid). The improvement is usually short lived though for reasons not fully understood.

First, very important: You need to consult your doctor especially regarding the use of disease-modifying anti-rheumatic drugs (DMARD's) like Enbrel (Embril) but also other drugs if you become pregnant after having had them prescribed for treatment of rheumatoid (rheumotoid, rhuematoid) arthritis.

Pregnancy improves on your rheumatoid arthritis

It has been known for several decades that RA (Rheumotoid Arthritis) often - but not always - will get better during pregnancy.The reason for this improvement as observed remains largely unknown but there are several theories on what may be causing this effect:

• Hormonal changes during pregnancy (increased levels of hormones such as estrogen or cortisol)
• Humoral immunity changes
• Changes in neutrophil function, such as a possible decrease in neutrophil respiratory burst
• Increased levels of cytokines (anti-inflammatory)

There are relatively few scientific studies covering the effect of RA (rhuematoid arthritus) in pregnant patients. Except from the improvement in RA symptoms that has been observed, there seem to be no other adverse effects such as increased morbidity, fetal outcome, etc.

Fertility in general seems almost unrelated to RA (rhumatoid arthrities) although a longer time to conception has been observed and it has also been noticed in some studies that married women with RA (rhematoid arthiritis)  have smaller families. There may be explanations such as changes in sex drive, ovulation etc.

RA (rheumatiod arthiritis) affects women more frequently than men, the rate is typically 2-3 times as common in female patients than males.

Most research on RA and pregnancy has been directed towards complications in RA patients related to their pregnancy and to possible effects and side effects of RA medication used. 

Pregnancy and RA medication

Arthritis medications can be used during pregnancy, but none of them is considered entirely safe. The use of NSAID's should be halted at start of a menstruation cycle when you are planning to get pregnant. The reason here is that NSAID's have been shown to have interference with blastocyst implantation in studies of animals. Possible side-effects on the mother could be prolonged gestational period and labor as well as increased anemia.

The use of corticosteroids is considered to be reasonably safe during pregnancy. These steroids are very powerful anti-inflammatory agents. There are small risk level increases for gestational diabetes, osteoporosis, edema and hypertension to mention a few.

Methotrexate or leflunomide should not be used due to their teratogenic effects.

Azathioprine can be used if your doctor judges that it is worth the slightly increased risk. It is recommended to discontinue the use of cyclosporine or cyclophosphamide at least three months before planned conception.