Many women with rheumatoid arthritis will experience an improvement of pain during pregnancy but some will still experience flare ups during pregnancy. The improvement of arthritis is usually caused by the many immune system changes during pregnancy. These changes are the ones which help the fetus to grow.
A study done by Dr. Zhen Yan, a professional research fellow in Dr. Lee Nelson’s lab show that prenatal diagnosis tests have been able to establish that fetal cells and cell free DNA usually flow to the mothers bloodstream during pregnancy. Dr. Yan and colleagues from the Centers Clinical Research Division decided to investigate whether the changes in blood fetal DNA levels have an effect on the arthritis activity during pregnancy.
The research was done on 25 pregnant women who suffer from inflammatory arthritis. The women age ranged from 23 to 43 years. Six of the women had Juvenile Idiopathic Arthritis (JIA) and 17 women had adult onset rheumatoid arthritis.
Six months before pregnancy, 24 women had active arthritis and only one experienced rheumatoid arthritis onset in the first three months of pregnancy.
Out of the 25 women, 7 were in their second pregnancy, 7 were in their first pregnancy and 11 of them had been pregnant atleast twice before. No patient took disease-modifying anti-rheumatic drugs during pregnancy and the ones who took prednisone took less than 10milligrams per day, only one took more than 10mg. All the patients gave a single live birth.
Three or more samples were taken from each patient during their pregnancy and also during the few postpartum months period. The real time qualitative polymerase chain reaction was used to measure the levels of cell free fetal DNA which targeted fetus-specific genetic markers.
Evaluation was done to all patients after three months of the pregnancy and three to four months after the pregnancy.
The results of the tests were as follows:
21 women of the total 25 women who represent 79% of RA patients and 100% of Juvenile Idiopathic Arthritis patients experienced improvement of the arthritis symptoms. Of the women who experienced improvement, 62% showed improvement of the disease in the first three months of pregnancy. To the women the improvement was sustained while to others it was increased progressively until pregnancy and the levels of serum fetal DNA went up throughout the pregnancy.
As the fetal DNA was going up there was improvement of arthritis too. Three to four months after the delivery the symptoms recurred, 90% of the patients recorded a drop of serum fetal DNA with some levels reaching undetectable levels. The other four women did not experience significant reduction* of arthritis symptoms during and after their pregnancy. Their levels of fetal DNA were low and two of them had their levels of fetal DNA not detected especially in the last three months.
Even though the study showed reduction* between arthritis activity and serum fetal concentration during pregnancy and postpartum, the researchers acknowledged some limitations such as its inability to show whether serum fetal DNA has any direct biologic effect on inflammatory arthritis and the small size of the study.
A pregnant mother will experience some discomforts which are similar to those of rheumatoid arthritis. Some of the pregnancy discomforts include:
- Swelling of the feet, hand and ankles.
- Hands pain and numbness. This is commonly caused by carpal tunnel syndrome of pregnancy.
- Breathe shortness.
Some women with rheumatoid arthritis flares will require medication though some of the drugs can pose a threat to the fetus. Before you start taking any form of medication during pregnancy you should ensure you know the benefits so as to compare them with its potential risks.
You should ensure you consult a rheumatologist and an obstetrical provider so that you can know how to take care of your pregnancy. The drugs for treating arthritis during pregnancy will depend upon the activity of the disease, individual factors, overall medical status and response to the treatment. The effects of the drugs on the fetus are not clearly known but some drugs should be avoided.
Drugs such as methotrexate and leflunomide should not be used during pregnancy. If you take one of these drugs you should consult your doctor immediately.
Some medication can only be taken at certain periods during the pregnancy. For example non-steroidal anti-inflammatory drugs (NSAIDs) are safe when taken during early pregnancy period but not late during the pregnancy. It is advisable to restart again RA medication after pregnancy because it has been approximated that 90% of patients of rheumatoid arthritis will experience flare ups during postpartum period.
It is not clear yet if breastfeeding can have an effect on arthritis patients but the postpartum period is when the mother breastfeeds the baby. It is not clear to establish whether breastfeeding increases* the risk of arthritis flares. Breastfeeding mothers should ensure they do not take some medication such as aspirin, methotrexate, cyctosporine and azathioprine.
Prednisone can be taken but in low doses. Other drugs that should be avoided include tumor necrosis factor (TNF) inhibitors such as infliximb and adalimunab though there has been insufficient information regarding their safety.
- Hench PS. The ameliorating effect of pregnancy on chronic atrophic (infectious rheumatoid) arthritis, fibrositis, and intermittent hydrarthrosis. Proc Staff Meet Mayo Clinic1938;13:161–7.
- Neely NT, Persellin RH. Activity of rheumatoid arthritis during pregnancy. Texas Med1977;73:59–63.
- Unger A, Kay A , Griffin AJ, Panayi G . Disease activity and pregnancy associated alpha2-glycoprotein in rheumatoid arthritis during pregnancy. BMJ1983;286:750–2.
- Nelson JL, Hughes KA, Smith AG, Nisperos BB, Branchaud AM, Hansen JA. Maternal-fetal disparity in HLA class II alloantigens and the pregnancy-induced amelioration of rheumatoid arthritis. N Engl J Med1993;329:466–71.