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Family Planning and Rheumatoid Arthritis

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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.

5. Work With Your Doctor on Rheumatoid Arthritis Treatment During Pregnancy

Your rheumatologist will help you decide on a treatment plan that includes both control of your RA symptoms and safety for your baby.

Low-dose prednisone, for example, is generally considered safe during pregnancy. Hydroxychloroquine (Plaquenil) and sulfasalazine are also considered safe. While evidence is limited for biologic medicines like Enbrel and Remicade, 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, through delivery and breastfeeding.

This method has its own risk, of course: possible progression of joint damage from flares during the time when you are off treatment. In certain women, though, some rheumatologists endorse the approach, with close monitoring for disease activity.

6. Expect Improvement in Rheumatoid Arthritis Symptoms During Pregnancy

Interestingly, pregnancy usually has a positive effect on rheumatoid arthritis symptoms, albeit temporary. About 70% to 80% of women experience improvement in their RA symptoms during pregnancy.

In many of these women, drugs for RA may be safely reduced or even eliminated during pregnancy. For about one-quarter of women, though, rheumatoid arthritis activity continues during pregnancy, or gets worse.

Unfortunately, the respite from RA symptoms during pregnancy is short-lived. Most women relapse after delivering their babies.

7. Until You're Ready to Get Pregnant, Use Contraception

Again, remembering the potentially harmful effects of some rheumatoid arthritis drugs on the fetus, it's essential to avoid pregnancy until you're ready. Experts say that used properly, a variety of methods are appropriate and effective, such as:

  • Condoms
  • Oral contraceptives
  • Vaginal ring
  • Intrauterine device (IUD)

Although controversial studies have suggested oral contraceptives might prevent rheumatoid arthritis in some women, there is no evidence that they help control RA symptoms.

WebMD Medical Reference

Reviewed by David Zelman, MD on June 10, 2013
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