Rheumatoid arthritis (RA)
Are you a clinician? See the clinical version of this page.
- Switch off methotrexate and onto pregnancy-compatible medicines before trying to conceive.
- Plan for the postpartum period; flares are common then.
- Settling your arthritis before you start trying is linked to becoming pregnant sooner.
- With planned treatment, good disease control through pregnancy is a realistic goal to aim for.
What to know
Will pregnancy affect my RA?
Improvement is less common than older reports suggested. In one prospective study, among people whose RA was at least moderately active early in pregnancy, at least 48 in 100 improved meaningfully. People who started with low disease activity mostly stayed stable. About 39 in 100 flared after birth. Care has changed since then. In a later group from the same team, treated with medicines aimed at keeping the disease quiet, more women had low disease activity or were in remission late in pregnancy: about 90 in 100, compared with about 47 in 100 in the earlier group. Severe flares after birth were not seen in that later group, though milder flares still happened.
Will RA affect the pregnancy?
Most pregnancies go well. Active disease can slightly raise the chance of early birth or a smaller baby, which is another reason to keep RA controlled.
Fertility
If you have rheumatoid arthritis, it can take longer to become pregnant, and how active the disease is accounts for a good part of that. This is worth raising at an appointment before you start trying, because it is one of the few parts you and your team can work on. In one Dutch clinic, women whose arthritis was quiet before they started trying became pregnant sooner than women whose arthritis was still active: a median of about 2 months compared with about 5 months. Across everyone in that clinic the median was about 3 months, compared with about 8 months in a group treated years earlier, when many women took no arthritis medicine at all while trying. Numbers like these describe groups rather than individuals, and your own experience may be different.
Planning ahead
Stop methotrexate or leflunomide before trying, and switch to pregnancy-compatible medicines that keep you well.
Medicines
Hydroxychloroquine, sulfasalazine, azathioprine, and TNF inhibitors can usually be used. Steroids help short-term for flares at the lowest helpful dose.
After birth
Flares are common after birth, so your team plans ahead to restart or adjust medicines, including ones that suit breastfeeding.
The numbers, in plain terms
at least 48 in 100
Among people whose RA was at least moderately active early in pregnancy, at least 48 in 100 improved meaningfully during pregnancy.
39 in 100
About 39 in 100 people had at least a moderate flare after birth.
When to call your team
- A significant flare with many swollen, painful joints.
- Any pregnancy red flags on your general pregnancy information (bleeding, reduced movements, severe headache).
- Before stopping or changing any medicine.