/publications/issue/2007/2007-06/2007-06-6601

Pregnancy OK with Rheumatoid Arthritis

Author: Dana A. Brown, PharmD

About 2 million Americans have a condition known as rheumatoid arthritis. People of all racial and ethnic groups may have this disease.

Rheumatoid arthritis is a chronic condition?one that unfortunately will continue for a long time. It occurs in more women than men. Women who may become pregnant may have it.

This disease causes pain, redness, swelling, stiffness, and limited movement of the joints. Your joints may feel stiffest in the morning. This feeling may last for more than an hour.

Most often, you will feel stiffness in your hands and feet, but any joint may feel stiff. The disease also may affect your heart and lungs.

No one knows what causes rheumatoid arthritis. Your immune system, however, is no longer able to recognize your body?s own tissues, such as in the joints. Cells of your immune system begin attacking your joints.

Becoming Pregnant
For years, women may have been told to avoid becoming pregnant if they have rheumatoid arthritis. You may have been told that both the disease itself and the medications you take for it may cause problems.

The condition does not affect a woman?s ability to become pregnant, although it may take longer. If you stay under your doctor?s care and use medications carefully, you may have a successful pregnancy.

If you are interested in becoming pregnant, you should first go to your doctor and find out how well your disease is under control. Your condition generally should be under control for at least 3 to 6 months before you try to become pregnant.

Medications
Some of the medications used in the treatment of rheumatoid arthritis can be harmful to your unborn baby. Some remain in the body for a long time after you have stopped taking them.

Examples of these medications are Arava and Rheumatrex. You would need to stop taking these drugs weeks to months before you become pregnant.

If you are taking Arava, you may have to take another medication to ?wash out? that drug before you become pregnant.

There also is a risk that your baby will have problems if you become pregnant by a man who is taking Rheumatrex. Thus, it is important to understand which medications are safe to take during pregnancy (see the Table).

Some medications that people take for rheumatoid arthritis will reduce pain and soreness or stiffness. Others will prevent the disease from worsening.

Medications for Pain and Soreness
Drugs such as ibuprofen (for example, Advil) or naprox-en (for example, Aleve) are used to reduce soreness and pain. They usually are considered safe in pregnancy except in the last 3 months. If you take these drugs in the last 3 months, you will have an increased risk for bleeding, for having a longer pregnancy and labor, and for having problems with the baby?s blood vessels that lead to the heart and lungs.

If you need pain relief in the last 3 months of your pregnancy, acetaminophen (for example, Tylenol) may work for you. It is considered safe during this time.

Other drugs, such as prednisone, may be used safely in pregnancy at low doses to reduce soreness. When taking these drugs, you will have a risk for high blood pressure, swelling, and high blood sugar levels?especially if you have diabetes. Thus, you should take the lowest dose possible. If you are taking these drugs, you also may need to take calcium and vitamin D to prevent any harmful effects on your bones.

Medications to Slow Down the Disease
Newer treatments for rheumatoid arthritis will slow down the course of the disease. These drugs include Enbrel, Humira, Kineret, Orencia, Remicade, and Rituxan.

Not enough is known about the safety of these new drugs. Further studies are needed. So they are not recommended for use during pregnancy. If you are now taking one of these medications and you wish to become pregnant, your doctor may stop your treatment.

Older drugs that also slow down the disease include Azulfidine and Plaquenil. They generally are considered safe for use in pregnancy if you need medication for your disease.

After You Become Pregnant
The good news is that the symptoms of rheumatoid arthritis may improve while you are pregnant, beginning in the first 3 months. As a result, you may be able to avoid taking medications during pregnancy.

However, some women have flare-ups of their disease about 3 to 4 months after the baby is born. If you are breast-feeding, you will need to discuss the safe use of medications with your pharmacist or your doctor. Some medications may be passed along to the baby through breast milk.

Conclusion
If you have rheumatoid arthritis and want to become pregnant or are pregnant, you should remain in close contact with your doctor. He or she can provide information and watch you closely during your pregnancy.

The more you know about your condition and the medications you may use if you are pregnant, the better. You need to take good care of yourself. If you do, you may have a safe and healthy pregnancy.

Dr. Brown is an assistant professor of pharmacy practice at Lloyd L. Gregory School of Pharmacy, West Palm Beach, Fla.