Rheumatoid Arthritis During Pregnancy: Symptoms and Treatment

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What is Rheumatoid Arthritis?

Rheumatoid arthritis is a chronic inflammatory disease that primarily affects the joints. The main symptoms of the disease are joint swelling, pain, and stiffness, caused by chronic inflammation and destruction of joint surface tissue. The most common joints to be affected are in the feet and hands. Other symptoms such as fatigue and morning stiffness are common. Sometimes this disease can also cause symptoms in the skin, lungs, heart, and eyes.

This is an autoimmune disease, which means that it develops as a result of an immune system dysfunction. A normal healthy immune system only attacks t\what it recognizes as foreign, such as bacteria, viruses, and parasites, and their products. Sometimes, however, the immune system can malfunction in such a way that it becomes sensitized to one or more proteins that the body itself produces. If this happens, the immune system might attack these proteins. This causes a disease state called autoimmunity, in which one or more types of body tissue are progressively destroyed.

In the case of rheumatoid arthritis, the immune system is primed to destroy certain proteins that are located in high concentrations in the joints.

Rheumatoid arthritis is a chronic, incurable disease, but can sometimes enter into a period of remission. A remission state can last months or years, but can end at any time.

The Connection Between Rheumatoid Arthritis and Pregnancy

For largely unknown reasons, many women with rheumatoid arthritis experience a partial or full remission during pregnancy. In one 1988 study, 63% of women experienced improvement in symptoms, and 16% were in remission, by the third trimester of pregnancy.

While the nature of the connection between rheumatoid arthritis and pregnancy is unclear, there are several theories that attempt to account for these effects.

  • Changes in levels of hormones such as estrogen, progestin, and cortisol might dampen symptoms.

  • Pregnancy causes certain changes in the immune system, such as increased levels of proteins that inhibit inflammation, and altered function of pro-inflammatory immune cells.

  • Genetic differences between the mother and fetus influence the immune system, leading to reduced inflammation.

Many women with rheumatoid arthritis find that pregnancy reduces fatigue and morning stiffness, and also reduces the severity of joint symptoms. However, in some cases, these improvements can be followed by disease flare-ups during the first few months after birth. Again, this is thought to be due to changes in hormone levels, or immune chemical or cell changes.

Rheumatoid Arthritis Treatment during Pregnancy

Although many women experience a full or partial remission of their symptoms during pregnancy, certain problems with rheumatoid arthritis treatment can arise.

The main issue is that no medications used in the treatment of rheumatoid arthritis symptoms have been proven to be safe for use by pregnant women. The use of certain medications during pregnancy can increase the risk of birth defects or other problems arising.

For this reason, it is important that a woman with rheumatoid arthritis plan her pregnancy carefully, so that she can discontinue the use of her medication, or switch to a new medication, if necessary. It is safest if these changes are made before conception.

Men with rheumatoid arthritis might also need to consider medication changes, especially if taking methotrexate. Again, any medication changes must be made before conception.

Anyone who has rheumatoid arthritis and is considering having a child should therefore consult with their doctor to determine what, if any, medication changes are needed prior to conception.

References

Alan K. Matsumoto, M.D. , Joan Bathon, M.D. and Clifton O. Bingham III, M.D. for the Johns Hopkins Arthritis Center: Rheumatoid Arthritis Treatment

Arthritis Foundation Arthritis Today: Pregnancy and Rheumatoid Arthritis

Johns Hopkins Arthritis Center Newsletter: A Mother’s Tale: Pregnancy & Rheumatoid Arthritis (PDF)

Katherine Temprano, MD, for eMedicine: Rheumatoid Arthritis and Pregnancy