Have Patience As You Try To Get Pregnant
Experts disagree on whether rheumatoid arthritis reduces fertility in women or men. It’s true that many women with RA take longer to conceive. Uneven ovulation, lowered sex drive, or having sex less often due to pain and fatigue are possible reasons.
For men, acute flares of rheumatoid arthritis temporarily reduce sperm count and function, and they can cause erection problems and lower sex drive. For both men and women, effective treatment for RA improves sexual symptoms and function. With the right treatment, fertility in most men and women is probably normal.
Breastfeeding And Bottle Feeding
Australian guidelines recommend exclusive breastfeeding for babies to around six months of age. Breastfeeding is then recommended to continue alongside suitable foods for infants until 12 months or age and beyond, for as long as the mother and child wish.
Whether to breastfeed or not, or for how long, is a very personal decision. Even mothers without arthritis can have issues that can prevent breastfeeding, or make it very difficult.
There are usually no physical reasons that prevent women with arthritis from breastfeeding, apart from possible discomfort if you and your baby are not positioned correctly during feeding. You can get advice on this from your child health nurse or lactation consultant at your local hospital. The choice to either breast or bottle feed your baby will depend on many factors, such as your milk supply, your baby and the medications you are taking.
Breastfeeding and medications
Many arthritis medications are safe to take during breastfeeding as they do not pass into breast milk, or only in very low levels that are safe for the baby. Others can pass into your breast milk and will not be safe for your baby. Talk to your healthcare team, including your rheumatologist, about your plans for breastfeeding so that the best treatment plan, for both you and your baby, can be put into action when your baby is born.
See the table above for a summary of the safety of arthritis medications during breastfeeding.
Breastfeeding and joint pain
Here are some tips:
Autoimmune Disease Congenital Heart Defect And Neurodevelopmental Disorders
A 2017 a review focused on the long-term outcome of children born to women affected by RA and Systemic Lupus Erythematosus. As previously reported, these data were also derived by national registries, with all the limitations related to this data collection. The authors concluded that these children could be potentially at increased risk of neurodevelopmental disorders, congenital heart defects and autoimmune diseases, compared with children from the general population. Genetic factors, obstetric complications, maternal autoantibodies, cytokines and drugs might be related to the increased risk. However, the extremely low rate of these events is overall reassuring: the absolute risk is small, and patients should not be discouraged from having children .
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Treating Arthritis During Pregnancy
The way that a woman normally treats arthritis is likely to change during pregnancy due to the risk of medication on an unborn baby. Instead of oral medications that come with a risk of side effects, doctors may recommend topical arthritis pain relief creams, like JointFlex. Fortunately, the worsened arthritis symptoms during pregnancy will often subside once the baby is born.
Light exercise on a regular basis can help alleviate joint pain in pregnant women,7as well as hot and cold therapy.8 Women can try taking a warm bath, using a heating pad, or placing an ice pack on sore joints. Massage, acupuncture, and herbal treatments may be recommended by a doctor too. Pregnant women with arthritis should also avoid wearing high heels, practice good posture, and try deep breathing and relaxation techniques to reduce pain and discomfort.
The Influence Of Treatment Of Inflammatory Arthritis During Pregnancy On The Long
- 1Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and University of Brescia, Brescia, Italy
- 2Child Neurology and Psychiatry Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, Brescia, Italy
- 3Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- 4Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation , Moscow, Russia
- 5Obstetric and Gynecology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
- 6Department of Medicine B, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan, Israel
- 7Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
- 8I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation , Moscow, Russia
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Tumor Necrosis Factoralpha Antagonists
Medications in the antitumor necrosis factor -alpha class are commonly used in the treatment of RA. These agents have been labeled as class B medications animal studies have shown no harm to the fetus, but thus far, no randomized, blinded, placebo-controlled trials on potential teratogenicity in humans have been completed. Numerous case reports have shown positive outcomes with antiTNF-alpha use in pregnancy, with an incidence of spontaneous abortion and birth defects similar to that in the general population.
Pregnancy outcomes of 495 women on adalimumab, infliximab, etanercept, certolizumab pegol or golimumab were evaluated in a prospective observational multicenter cohort study and compared with 1532 outcomes from a non-exposed random sample. Major birth defects were reported in 5% of the exposed group as compared to 1.5% in nondiseased controls. The risk of preterm birth was increased, but not the risk of spontaneous abortion. Birth weights adjusted for gestational age and sex were significantly lower in the exposed group compared to the non-exposed cohort .
The individual TNF inhibitors differ in terms of placental transfer. Certolizumab may have a safety advantage, as smaller amounts of the drug are known to pass into fetal circulation.
The EULAR guidelines make the following recommendations for use of anti-TNF medications :
BSR-BHPR guidelines include the following recommendations :
Causes Of Arthritis In Pregnancy
Pregnancy as such does not lead to arthritis. It is the number of physical changes and events that could lead to certain forms of arthritis taking over the womans body.
One of those is osteoarthritis which is majorly observed in elderly people. This usually is a result of degeneration that takes place in the joint cartilage and is mostly a consequence of extended wear and tear of the body. During pregnancy, the weight gain that occurs tends to create a load on the joints, especially the larger ones such as hips, knees, and ankles. These undergo the most changes and tend to bear the largest load during pregnancy. This strain could result in pain and symptoms similar to osteoarthritis.
Another strange form of arthritis is rheumatoid arthritis. This is strange because it is actually a result of the response of the bodys immune system as it attacks the linings of the joints, resulting in inflammation. Fortunately, pregnancy tends to bring a reduction in this condition since the immunity system of the woman undergoes a metamorphosis due to it. However, the pain may resume after childbirth or sometimes, the change in the immunity system could make it worse. At times, discontinuing certain medicines could also cause this pain to continue.
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Follow Your Treatment Plan
You’re probably already following a treatment plan for your arthritis. Once you become pregnant you and your doctor may have to change some parts of this plan slightly. As a pregnant woman with arthritis your plan should include:
- arthritis medicines: know what arthritis medicines you’re taking and how they will affect your baby
- exercise: to keep your muscles strong and your joints flexible
- diet: eat a balanced diet
- joint protection: learn ways to ease joint pain and to reduce stress on your joints
- stress management: to help ease the emotional ups and downs of pregnancy.
Guide For Arthritis During Pregnancy
Arthritis is common and can happen to anyone at any age. Arthritis wont affect the ability to get pregnant. However, if you take medications for arthritis consult your doctor before you conceive. Certain medications can effect the unborn child, and some stay in your system for a time after you stop taking them. As arthritis seems to be curable and every pregnant women who is having arthritis will be curious to know about whether it affects the baby or not. No it doesnt seem to harm the baby anyhow.
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How Rheumatoid Arthritis Affects Pregnancy
If you’re pregnant or planning to be, you may wonder how having rheumatoid arthritis could affect your pregnancy. Here’s some good news: Many women with RA find that their symptoms go into remission during pregnancy. Whatâs more, RA doesn’t seem to affect your chances of getting or staying pregnant. However, certain RA medicines aren’t safe to take while you are pregnant. Here’s what you need to know about pregnancy and RA.
Does It Matter If The Father Is Taking Drugs For Arthritis
Cyclophosphamide is the only anti-rheumatic drug which we know for certain should not be taken by men wanting to try for a baby.
However, there are also drugs that we dont have a lot of information on, so its important to discuss these with your doctor.
But while the data can be limited, especially with newer drugs, current guidelines say that men are fine to take most drugs for arthritis if they want to have a baby.
For more information on drugs and pregnancy go to the drugs section of this page.
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Work With Your Doctor On Rheumatoid Arthritis Treatment During Pregnancy
Your rheumatologist will help you decide on a treatment plan that includes control of your RA symptoms and safety for your baby.
Low-dose prednisone, for example, is generally considered safe during pregnancy. Hydroxychloroquine and sulfasalazine are also considered safe. While evidence is limited for biologic medicines like etanercept , etanercept-szzs , infliximab , and infliximab-abda or infliximab-dyyb biosimilars, many rheumatologists are confident in their relative safety during pregnancy.
One way to avoid the risk of pregnancy problems from RA medications is to simply not take any. Under a doctor’s supervision, some women quit RA drugs “cold turkey” when they begin trying to conceive.
This method has its own risks, of course: possible progression of joint damage from flares during the time when you are off treatment. But some rheumatologists endorse this approach in certain women, with close monitoring for disease activity.
Test For Antiphospholipid Antibodies
You may need a blood test to check for antiphospholipid antibodies, as they can interfere with the bodys ability to regulate blood clotting. These antibodies are present in women with antiphospholipid syndrome and in about half of patients with lupus.
Antiphospholipid antibodies dont always cause problems, but they can increase the risk of pregnancy complications. So, if you test positive, youll usually see a consultant with expertise in high-risk pregnancies. Its likely youll be given a low-dose aspirin tablet to take every day to make your blood less sticky. You may also need daily injections of the blood thinner heparin.
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Pain Relief During Labour
Gas and air
This is a combination of oxygen and nitrous oxide. Gas and air can help reduce some of the pain during labour. Its easy to control as you breathe it in through a mouthpiece that you hold yourself.
Epidurals
Epidurals are a special type of local anaesthetic given into the back which, for most women, give complete pain relief. While usually a straightforward procedure, conditions like ankylosing spondylitis can make it more difficult. In these scenarios an anaesthetist can meet with you first to discuss the options.
Water births
Some women choose to have a water birth as it can help them relax during labour and make the contractions seem less painful.
If this is something youre considering, make sure you talk to your maternity team so you can make any arrangements well in advance.
Birth pools can be set up in your home, but your maternity ward may also have access to one.
TENS
TENS machines have small pads which are taped to your back and connected to a small battery-operated machine which produces a small current.
They have been shown to reduce some of the lower back pain that some women experience during the early stages of labour. But TENS machines arent effective during the later stages when the contractions become longer and more frequent.
If you wish to use a TENS machine speak to your midwife so that they can show you how it works.
Relaxation techniques
Treating Joint Pain And Knee Pain During Pregnancy
- Exercise: Regular exercise improves range of motion and can help keep your joints flexible. Low impact exercise, such as walking and swimming, is gentler on the joints.
- Hot and Cold Therapy:
- Try taking a hot shower or bath.
- Use a heating pad or electric blanket on your joints.
- Place an ice pack wrapped in a towel on your joints.
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What Precaution Should You Take
Try and stick to a good exercise schedule which keeps the joints and muscles strong and healthy. Use correct postures to distribute the weight evenly across the body and reduces any untoward pressure on the joints. Keep mental stress levels low and have a healthy diet that enriches any vitamins and nutrients needed to boost bone development.
Should I Take Drugs During Pregnancy
Historically, women were told that they should come off all arthritis medications before pregnancy. But now we know that many drugs can be taken safely.
Keeping your condition in check is really important if youre thinking of trying for a baby. So, you shouldnt just stop taking prescribed drugs without talking to your doctor first.
Its really important to discuss the medications available with your doctor, so that you can make an informed decision and get on the treatment plan thats right for you.
Check out the drugs section of this page for more information on drugs that are safe in pregnancy.
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Managing Psa During Pregnancy
Symptom control can often change during and after pregnancy. The degree of this change varies greatly between each person. Changes to your symptoms should be promptly discussed with your rheumatologist whether they are positive or negative.
Most pregnant women do not experience worsening symptoms or higher disease activity during or after their pregnancies. One MyPsoriasisTeam member posted, Mine went away completely while I was pregnant! But a second said, Mine was opposite. I have been pregnant four times, and every time, my skin flared up a lot. Another member commented, When I was pregnant, my psoriasis disappeared, and I had no problems with my arthritis. So, its different for everyone. Talk to your doctor about it, go for it, and see what happens. Good luck.
There is an increased risk for changes to your disease during gestation and after delivery because of medication and hormonal changes. One member stated, My psoriasis went completely when I was pregnant but came back very quickly after. This may be caused by fatigue or other postpartum period symptoms. Symptoms should be closely monitored by you and your doctor.
If you experience back or joint pain as a PsA symptom, childbearing may increase this pain as the baby grows and adds weight to these areas. General aches and pains from PsA are often increased during pregnancy. This pain also leads to higher levels of fatigue and tiredness during pregnancy. Discuss these symptoms with your obstetrician.
Which Rheumatoid Arthritis Drugs Are Safe During Pregnancy
None of the drugs used in the treatment of rheumatoid arthritis is completely safe during pregnancy. You must discuss with your physician the decision to use, modify, or stop any medications.
Pain control during pregnancy may be done through nonpharmacologic management such as paraffin baths, decreased physical activity, splinting, and cold packs as adjunctive care.
Corticosteroids: They are considered relatively safe in pregnancy when used in low doses and are designated as category B medications. Category B drugs are those which have been found to be safe in pregnant animals although they lack adequate studies in pregnant women. Corticosteroids have potent anti-inflammatory action. They may, however, increase the maternal risk of high blood pressure, swelling, increased sugars during pregnancy, poor bone health in pregnancy, premature delivery, low birth weight babies, and birth defects such as cleft palate in the newborn. Certain corticosteroids such as prednisone and hydrocortisone are safer for use without adverse events in the fetus.
Sulfasalazine: It is another important medication for RA. It is also a category B medication. Sulfasalazine does not put the developing baby at risk and is considered safe in pregnancy.
Tumor necrosis factor -alpha antagonists: These are commonly used in RA management. They belong to category B and are considered safe during pregnancy.
Hence, the ultimate decision to use a certain drug should be made only in consultation with the doctor.
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