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Am Pregnancy And Rheumatoid Arthritis

Pregnancy and Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an inflammatory disease of joint tissues with an unknown cause. For every five women who develop rheumatoid arthritis, only two men develop it. It’s classified as an autoimmune disorder, although it’s been theorized that your body’s immune system may be reacting appropriately to a hidden pathogen or compound that has become lodged within the joints of your hands, hips, spine or other synovial joints (those surrounded by a membranous capsule). Rheumatoid arthritis usually doesn’t prevent pregnancy or threaten your child, although it may contribute to the pain of the birthing process, especially is you give birth during an inflammatory flare.

If I have rheumatoid arthritis, will that affect my chances of getting pregnant?

For the vast majority of women with autoimmune diseases, such as rheumatoid arthritis, they can conceive without problem and safely have children. Notable exceptions are lupus, where there is a slightly higher risk of preterm birth or stillbirth, and myasthenia gravis, which causes some women to have trouble breathing during pregnancy. In regards to rheumatoid arthritis specifically, there is no evidence to suggest that it lowers fertility rates in women, unless your condition has led to significant weight loss. Women need some body fat in order to conceive. Having trouble conceiving has many causes and should be thoroughly investigated by your doctor. Certain tests can tell if fertility problems are caused by an autoimmune disease or an unrelated reason.

How might my symptoms change during pregnancy – better or worse?

For some women with autoimmune conditions, their symptoms improve during pregnancy, while others experience flare-ups. Rheumatoid arthritis is a condition that is likely to improve with pregnancy, though some women have reported worsening symptoms. It depends partially on which joints are affected, as well as hormonal changes. Weight-bearing joints such as the hips and knees might become more irritated as you gain weight during pregnancy. Your hands wouldn’t be affected much by weight gain, but they may become stiffer with edema, or fluid retention, which is common during pregnancy. The birthing process is likely to be more painful if you have rheumatoid arthritis in your hips, pelvis or lower back joints and are experiencing a flare during this period.

If I have rheumatoid arthritis plus other autoimmune conditions, what are the chances another autoimmune condition will onset during or just after pregnancy when my hormone levels are altered?

When their immune systems are triggered, women tend to have stronger inflammatory responses than men; inflammation plays a key role in many autoimmune diseases. With some autoimmune diseases there may be a change (either improvement or flares) with hormone fluctuations – such as those seen in pregnancy – which indicates that female sex hormones may play a role in these autoimmune disorders. Additionally, there is some evidence that fetal cells can remain in circulation for years in a woman’s body, and these foreign cells may be involved in the development or worsening of certain autoimmune diseases.

As for whether additional autoimmune conditions will arise during or after pregnancy, there is some evidence supporting this possibility, though it is also influenced by the fact that you already have one or more autoimmune diseases, which predisposes you to others. However, there is a considerable risk of flares in the postpartum period, usually within the first three months, which may lead some physicians to restart therapy relatively soon after you give birth. While hormone levels are not necessarily responsible for the onset of additional disorders by themselves, they may very well play a role in such developments, and may be involved in the rise of RA symptoms following childbirth.

Questions for your doctor:

  •  How could my RA complicate conception, pregnancy and delivery?
  • Is it better to wait until my RA is in remission before I attempt to get pregnant?
  • How might my RA medication affect my ability to conceive?
  • What fertility tests are available?

References
http://www.womenshealth.gov/publications/our-publications/fact-sheet/autoimmune-diseases.cfm#j
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1887926/
http://www.everydayhealth.com/autoimmune-disorders/understanding/women-and-autoimmune-diseases.aspx

AutoimmuneMom

About the Author
Dr. Rothbard is a professional medical writer and consultant based in New York City, specializing in medical education articles targeted at a variety of audiences, from children through clinicians.  After leaving medicine, he worked as a biology and medical science educator for several years, before deciding to pursue writing full-time.  He may be reached at grothbard@hotmail.com.

This blog post was originally published by AutoimmuneMom.com, written by Dr. Rothbard, and first published on Sep 9, 2012.

This post contains the opinions of the author. Autoimmune Association is not a medical practice and does not provide medical advice, diagnosis, or treatment. It is your responsibility to seek diagnosis, treatment, and advice from qualified providers based on your condition and particular circumstances. Autoimmune Association does not endorse nor recommend any products, practices, treatment methods, tests, physicians, service providers, procedures, clinical trials, opinions or information available on this website. Your use of the website is subject to our Privacy Policy.

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