What to Know About Arthritis and Pregnancy

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Arthritis refers to rheumatic diseases that cause inflammation, pain, and stiffness in joints. The most common types of arthritis are osteoarthritis and rheumatoid arthritis.

Osteoarthritis (OA), also called degenerative joint disease or wear-and-tear arthritis, happens over time as cartilage around joints wears down. Rheumatoid arthritis (RA) is an autoimmune disease in which the immune system mistakenly attacks the lining of the joints, often on both sides of the body at once, causing painful swelling and bone erosion.

OA doesn't affect fertility or the baby during pregnancy, but it can increase discomfort in your joints as your body is under additional strain from the growing baby. On the other hand, RA can have a significant impact on fertility, pregnancy, and the postpartum period.

Working with your medical team to keep RA under control can help you avoid complications and better your chances of giving birth to a healthy baby.

Pregnant woman standing with hand on back

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Rheumatoid Arthritis and Fertility

RA has been linked to infertility and difficulty in getting pregnant. One 2019 study showed that getting pregnant took more than 12 months in 42% of females with RA compared to 12% in the general population.

RA has been found to affect fertility in men, as well. RA medications like Asulfidine (sulfasalazine) have been linked to subfertility, which is reduced fertility for a long period of time during which conception does not happen. The drugs may cause a lack of sperm or reduced sperm motility, the ability of sperm to swim properly.

Subfertility has been linked to the use of nonsteroidal anti-inflammatory drugs (NSAIDs, like Advil, aspirin, and Aleve) in women with RA during the periconceptional period, which is the period immediately before and after conception.

RA is usually treated with disease-modifying antirheumatic drugs (DMARDs), but not all are safe to use if you are planning to become pregnant. For example, methotrexate (such as Trexall or Rasuvo) should be stopped at least three months before pregnancy because of its potential to cause birth defects. Talk to your rheumatologist and make sure it's safe to continue using your RA medications if you are considering becoming pregnant.

Having a better grasp on your condition will benefit not only your general health but also your pregnancy. Women who have well-controlled RA have healthier pregnancies and babies than those who have active disease at the time they become pregnant. It's recommended that RA should be controlled for three to six months before attempting to become pregnant.

Women who have uncontrolled rheumatoid arthritis may be at increased risk of complications, such as preterm birth and having babies that are small for their gestational age. It's therefore important for people with RA to plan their pregnancy with the help of their rheumatologist and ob-gyn.

Rheumatoid Arthritis Doctor Discussion Guide

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RA and Gestation

Your RA may be easier to manage during your pregnancy. Research has shown that disease activity improved in 60% of people with RA during pregnancy and flared in 46.7% postpartum. This may be due to hormonal and immune system changes in pregnancy that protect the unborn baby and are also beneficial to pregnant people with RA.

Risks

Pregnancy brings the risk of increased pain and worsening of symptoms in pregnant people with different types of arthritis. For instance, weight gain can place a burden on your knees, a change in posture can put pressure on your back, and increased hormonal levels, such as relaxin and progesterone, cause joints to loosen to allow you to deliver your baby.

Pregnant people with uncontrolled arthritis can also be at risk for complications, including preterm birth and having babies that are smaller than normal. Risks associated with arthritis have been linked to severe disease activity and the use of corticosteroids, synthetic anti-inflammatory drugs made to resemble the hormone cortisol. More research is required to confirm a direct link.

A 2017 study looking at patient-reported disease activity and adverse pregnancy outcomes found women with RA who reported disease activity also had adverse pregnancy outcomes.

Treatment

If the drugs you were taking at conception are controlling your disease, your doctor will likely have you continue them throughout pregnancy unless they are contraindicated (not advised due to possible harmful side effects) during pregnancy.

Arthritis and Postpartum

After giving birth, arthritis symptoms can increase if they were in remission (times when symptoms become less intense) during pregnancy. Postpartum flare-ups are common for a variety of reasons, including:

  • Decrease in anti-inflammatory steroid levels: After pregnancy, there is a decrease in anti-inflammatory steroid levels due to an increase in levels of the hormones estrogen and progesterone. After birth, these levels decrease and can trigger a flare-up due to the subsequent increase in inflammation.
  • Elevated levels of prolactin: Prolactin is a hormone that is elevated during lactation and has been found to increase inflammation and contribute to worse disease activity.
  • Change in neuroendocrine axis: The neuroendocrine system is essential to maintaining homeostasis (relative stability) within the body and in autoimmune diseases. When the neuroendocrine axis changes, hormone production also changes, leading to a flare-up.

Impact on Recovery

Those with or without joint pain before giving birth are likely to experience joint pain and discomfort after labor. This is due to the demands of pregnancy, labor, and changes in hormonal levels.

It’s important to work with your rheumatologist to manage your disease. Let your doctor know if you are breastfeeding. Many medications, but not all, are safe for breastfeeding.

Breastfeeding

There’s no evidence that RA lowers milk production, but some women experience pain when trying to hold their babies to breastfeed, especially if their RA is not well-controlled. While you can’t pass RA on to your baby by breastfeeding, some medications may be released in breast milk. Many medications are safe to use at this time, though, and the risk of medications being passed through breast milk is relatively low in many cases.

Summary

Pregnancy can exacerbate the joint pain caused by any type of arthritis because of the increased strain on your body as your baby grows. Besides rheumatoid arthritis, other types of arthritis generally don't cause issues with fertility and development of the baby. It's important to work with your rheumatologist and obstetrician to plan your pregnancy because some medications you take may not be safe for your baby. Also, keeping your condition under control can help prevent complications.

A Word From Verywell

Arthritis is a lifelong condition that can affect everyday life. Rheumatoid arthritis may impact fertility, but there are ways to successfully and safely get pregnant and give birth to a healthy child.

To best prepare for pregnancy, start a conversation about family planning with your healthcare team as early as possible. Work closely with your rheumatologist and obstetrician to determine the best options for your fertility, pregnancy, and postpartum treatments.

Frequently Asked Questions

Does arthritis in the knee get worse when you're pregnant?

Sometimes. Joint pain is common in pregnant people due to physical strain, increased weight gain, and the loosening of joints during pregnancy. While some people have lower disease activity during pregnancy, others may experience more severe symptoms, which can include worsening of pain in the knee.

How do you relieve arthritis pain while pregnant?

You can relieve arthritis pain with hot or cold packs. You can also do so by resting, keeping your feet elevated, practicing deep breathing, and avoiding uncomfortable positions or shoes. Medications, including corticosteroids, are safe during pregnancy at low doses. Work with your doctor to create a safe and effective medication regimen during pregnancy.

How do you treat rheumatoid arthritis if you want to get pregnant?

Your healthcare team, including your rheumatologist and obstetrician, can help you determine the best medications and treatments to control your RA without impacting fertility. For example, NSAIDs may be used sparingly since studies have linked NSAIDs to impaired ovulation, difficulty in conceiving, and miscarriage. Doctors may also recommend that you stop taking methotrexate three months before pregnancy.

Why does it feel like I have arthritis in my hands while pregnant?

Pain in your hands during pregnancy is common. Joint pain in the hands can be from changes to the body in preparation for the baby, including the loosening of joints, as well as edema (swelling) from increased blood production.

Studies have shown that the prevalence of carpal tunnel syndrome (CTS) in pregnant people is very high. CTS causes symptoms of numbness, tingling, and pain in the fingers and hand.

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