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.

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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 etanercept (Enbrel), infliximab (Remicade), and infliximab-dyyb (Inflectra), a biosimilar, 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.

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:

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 August 02, 2016

Sources

SOURCES:

Scott Zashin, MD, rheumatologist; spokesperson, American College of Rheumatology.

eMedicine.com: "Rheumatoid Arthritis and Pregnancy."

Medscape: "Pregnancy, Fertility, and Contraception Risk in the Setting of Chronic Disease."

Del Junco, D. The Journal of the American Medical Association, Oct. 11, 1985.

The Arthritis Foundation: "The Genetics Behind Rheumatoid Arthritis."

FDA. “FDA approves Inflectra, a biosimilar to Remicade.”

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