Arthritis & Allergy

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Pregnancy and Rheumatoid Arthritis

Because rheumatoid arthritis often affects women of childbearing age, I am often asked what to expect during pregnancy. That’s exactly what Amelia, a thirty-five year old RA patient was concerned about; Will her arthritis affect her pregnancy? Will her medications affect her baby? And will becoming pregnant make her RA worse?

My answer: “Actually, about 75% of women affected with RA, who become pregnant, notice significant improvement in joint pain and swelling even without medication, particularly at the third trimester, while 20 % of women fail to improve and 5% get worse. Some of my patients have felt “the best they’ve ever felt” while being pregnant. And even though several studies have shown an increased risk of miscarriage for patients with RA, there is no existing evidence that RA affects fertility or a developing fetus. Nonetheless, when a pregnant women whose RA is very severe and active or requires aggressive pharmacologic treatment, adverse effects that may pose a risk to the developing fetus.”

Amelia was delighted, but still curious. I responded that even though the process is not yet fully understood, it is evident that complex changes within a pregnant woman’s immune system not only allows a fetus, a partially “foreign intruder”, to survive within the uterus, but can potentially impede the inflammatory process of rheumatoid arthritis, if she has it. Interestingly, most women will notice their RA flare within six to eight months after delivery, and some 10% of those during the first two weeks.

Scientists are looking at human alpha fetoprotein (hAFP), which is produced by fetus and released to the mother from the first trimester, reaching peak levels during the third trimester. Unlike current RA “immuno-suppressive” medication that weakens the immune system, hAFP is an “immuno-modulator” (mediator), not suppressor, and may be linked to the improvement of RA during pregnancy.

Currently, if necessary, low dose NSAIDs and aspirin can be taken, but must be stopped several weeks before expected delivery. If NSAIDs fail, low dose Prednisone, possibly the safest drug of all, can be used. And even though Plaquenil and Azulfadine have shown no negative effects only low doses should be used when really necessary. Because of lack of data, anti-TNF such as Enbrel, Humira and Remicade should be avoided. Lastly, Methotrexate should never be taken during pregnancy and should be stopped several months prior to conception.

I recently saw Amelia, who has felt “like a new woman” for more than twelve months. She was just starting to flare, but she had a beautiful healthy baby girl on her lap.

Hopefully, thanks to ongoing medical studies of the benefits and safety of AFP therapy for RA patients, many other RA patients can feel “like new” again.

By Dr. Yong H. Tsai
Published in The Daytona Beach News-Journal
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