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Family Planning and Rheumatoid Arthritis

Although anyone can get rheumatoid arthritis, women with RA outnumber men by about three to one. Many women with rheumatoid arthritis are diagnosed in their 20s and 30s, just when marriage and family start to take life's center stage.

With pain, fatigue, and medication side effects to consider, there's no question rheumatoid arthritis makes family planning more complicated. But RA doesn't have to put your dreams of having a family out of reach. If you're thinking about starting a family while living with rheumatoid arthritis, consider these tips.

1. Don't Worry That Rheumatoid Arthritis Could Hurt Your Baby

Rheumatoid arthritis itself doesn't seem to harm the developing baby, even if RA is active during pregnancy. In fact, 70% to 80% of women with RA have improvement of their symptoms during pregnancy. Although some women with RA may have a slight risk of miscarriage or low-birth-weight babies, the vast majority of women have normal pregnancies without complications. 

However, many drugs for rheumatoid arthritis -- including methotrexate and leflunomide -- can cause birth defects. These same medications may also cause birth defects if they are taken by men who father children. Therefore, it's important to talk to your doctor about altering treatment several months before you or your spouse try to get pregnant.

With the right treatment and prenatal care, babies born to moms with rheumatoid arthritis are as healthy and happy as any.

2. Have Patience As You Try to Get Pregnant

Experts disagree whether rheumatoid arthritis reduces fertility in women or men. It's true that many women with RA take longer to conceive than women without rheumatoid arthritis. Inconsistent ovulation, decreased sex drive, or having sex less often due to pain and fatigue are possible explanations.

For men, acute flares of rheumatoid arthritis temporarily reduce sperm count and function, and can cause erection problems and decreased libido. For both men and women, effective treatment for RA improves sexual symptoms and function. In well-treated rheumatoid arthritis, fertility in most men and women is probably normal.

3. Know That the Future Looks Bright for Rheumatoid Arthritis Treatment

New biologic drugs for RA have created a new era of treatment for rheumatoid arthritis, according to rheumatologists. With early and aggressive treatment, most people with RA can avoid joint deformities and major disability.

For most women, that means being present and active throughout your children's years at home. While bad days from RA symptoms may be unavoidable, doctors believe most women will keep their independence for decades, and possibly their lifetimes.

4. Alter Rheumatoid Arthritis Treatment Well Ahead of Your Pregnancy

As soon as you're considering starting a family, see your rheumatologist. Some drugs need a months-long "washout" period before trying to conceive. And that goes for men as well as women; although unproven, methotrexate might result in sperm problems that could cause birth defects.

If you're taking leflunomide for RA, even more advance planning is necessary. Due to its long half-life, leflunomide needs to be stopped two years before trying to conceive a baby, although there are ways to "wash" it out of your system quicker.

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