Arthritis pain often eases with pregnancy

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Arthritis pain often eases with pregnancy

By DR. YONG H. TSAI

MANAGING PAIN

Last update: April 04, 2005

Because rheumatoid arthritis often affects women of childbearing age, I

am often asked what to expect during pregnancy.

That's exactly what Amelia, a 35-year-old arthritis patient was

concerned about: Will my arthritis affect my pregnancy? Will

medications affect my baby? And will becoming pregnant make my

rheumatoid arthristis worse?

My answers surprised her.

Actually, about 75 percent of women affected with rheumatoid arthritis,

who become pregnant, notice significant improvement in joint pain and

swelling even without medication -- particularly at the third

trimester.

Another 20 percent of women fail to improve and 5 percent do get worse.

But some of my patients have felt " the best they've ever felt " while

being pregnant.

And even though several studies have shown an increased risk of

miscarriage for patients with this form of arthritis, there is no

existing evidence that it affects fertility or a developing fetus.

Nonetheless, when a pregnant women whose arthritis is very severe and

active or requires aggressive pharmacologic treatment, adverse effects

may pose a risk to the developing fetus.

Amelia was delighted with my answers, but still curious. I responded

that the process is not yet fully understood. But it is evident that

complex changes within a pregnant woman's immune system not only allow

a fetus -- a partially " foreign intruder " -- to survive within the

uterus, but can impede the inflammatory process of rheumatoid

arthritis, if the mother has it.

Interestingly, most women will notice their arthritis flare up within

six to eight months after delivery -- 10 percent in the first two

weeks.

Scientists are looking at human alpha fetoprotein (hAFP), produced by

the fetus and released to the mother from the first trimester, reaching

peak levels during the third trimester.

Unlike current arthritis " immuno-suppressive " medication that weakens

the immune system, hAFP is an " immuno-modulator " (mediator), and may be

linked to arthritis improvement during pregnancy.

Currently, if necessary, low dose non-steroid anti-inflammatory drugs

and aspirin can be taken, but must be stopped several weeks before

expected delivery. If NSAIDs fail, low dose Prednisone, possibly the

safest drug of all, can be used. And while Plaquenil and Azulfadine

have shown no negative effects, take low doses only if really

necessary.

Because of lack of data, drugs like Enbrel, Humira and Remicade should

be avoided. Lastly, Methotrexate should never be taken during pregnancy

and should be stopped months before conception.

I recently saw Amelia, who has felt " like a new woman " for more than 12

months. Her arthritis was just starting to flare, but she had a

beautiful healthy baby girl on her lap.

Hopefully, thanks to ongoing medical studies of the benefits and safety

of AFP therapy for rheumatoid arthritis patients, many other similar

patients can feel " like new " again.

Dr. Yong H. Tsai is board-certified in rheumatology, allergy and

clinical immunology and has been practicing in this area for several

years.

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