Axial spondyloarthritis (axSpA)
Are you a clinician? See the clinical version of this page.
- Do not expect axSpA to automatically ease in pregnancy; plan for ongoing symptom control.
- TNF inhibitors are often the mainstay for keeping axSpA controlled in pregnancy.
What to know
Will pregnancy affect axSpA?
For most people with axSpA, disease activity stays low and fairly stable from before pregnancy through the first year after birth. It tends to be highest in the second trimester, when about 45 in 100 have active disease. Unlike rheumatoid arthritis, a clear flare after birth was not seen in the largest study.
Will axSpA affect the pregnancy?
Most pregnancies go well. There may be a slightly higher chance of early birth or a caesarean, partly related to hip and pelvic symptoms.
Fertility
Fertility is usually normal. Heavy use of anti-inflammatory painkillers around the time you are trying can make conceiving harder.
Medicines
Anti-inflammatory painkillers can be used earlier in pregnancy then stopped later on. TNF inhibitors are often continued to control the disease. Steroids play a smaller role than in some other conditions.
Staying active and comfortable
Keeping moving, physiotherapy, and posture and pain strategies matter a lot in axSpA, since medicines are only part of the picture.
After birth
Plan which medicines to restart after birth. In axSpA, a strong postpartum flare is less predictable than in rheumatoid arthritis; many people restart anti-inflammatories or a TNF inhibitor, most of which suit breastfeeding.
The numbers, in plain terms
45 in 100
About 45 in 100 women with axSpA had active disease in the second trimester, the point when it tends to peak.
When to call your team
- Severe or worsening back or hip pain that limits walking.
- General pregnancy red flags (bleeding, reduced movements, severe headache).
- Before changing any medicine.