pregnancy and rheumatoid arthritis

[raj1980]

hello Doctor,
.This is actually concerned with my sisters health.
She was diagonised for RA during MAY 2008.
That time her RF was 414 and her ESR was 80.
she was put under medications of methotrexate -7.5 mg and also hydrochloroquine sulphate
now she is taking 15 mg methotrexate.
She is 29 years old and have a child of 4 years.
She wants to plan fr another baby now.
last month her ESR report was around 38. and this month it is 35
although the ESR rate is high she is very comfortable with her body with no morning stiffness.
so she wants to stop the medications.
My questions are
1. Is it ok if she stops her medications if her ESR is under control
2. what medications can she take while trying to conceive and during
pregnancy?
3.Will her RA affect her pregnancy and foetus
4. Can she stop these medications instantly
5.what meds can she take when she is trying to conceive
She is very concerned about conceiving doctor,So please guide us properly
about this topic.Plz reply back.

Thanking u,
Pushkala,

[Bhupinder Kaur, MD]

Hello,

Your daughter can’t stop taking methotrexate on her own.She has to consult her rheumatologist as well as her gynecologist if she is planning pregnancy.I had earlier also stressed that when methotrexate is stopped,other medicines are started.These medicines are chosen such that they have no adverse effects on the RA as well as on the fetus.Pregnancy in RA is a very high risk case and the gynecologist that she will be consulting and the treating hospital should have all knowledge and facilities for high risk preganancy respectively.

The key to dealing with all the issues regarding pregnancy in those with rheumatoid arthritis is to start early discussions with the doctors-both the rheumatologist and the gynecologist. With everyone in the loop and awareness and planning a safe pregnancy is possible. http://www.rheumatoidarthritisnews.com/pregnancy-and-rheumatoid-arthritis.php

Hope it helps.Take care and pls do keep me posted on how you are doing or if you have any additional queries.

[raj1980]

hello

thanks for ur reply
Now the ESR value is 46 -if she stops her methotrexate----will this get her pain back and increase the ESR value
can she stop her methotrexate when her esr value is high.
i am very scared to ask the docyor about conception coz in india they told tht the disease shold be under contol
thanku

[Bhupinder Kaur, MD]

Hello,

When your daughter will stop methotrexate(3 months prior to conception),her doctor will prescribe her alternates of medicines to that.Moreover she will continue with hydroxychloroquine.After pregnancy i.e during her first trimester, most of the medicines will be stopped and her condition of RA observed.As I have told you earlier also,RA mostly improves during pregnancy.If however her symptoms are still there then medicines considered to be a bit safe in pregnancy like steroids and Anakinra, tumor necrosis factor-a (TNF-a) inhibitors and rituximab  may be started.Moreover pain control through nonmedical management (eg, paraffin baths, decrease in physical activity, splinting, cold packs) will prove useful. A low-fat, high-carbohydrate diet with high-fiber content is recommended .However, Fish oils in moderate quantities can be taken during pregnancy.

Methotrexate is classified as an antimetabolite drug which means it is capable of blocking the metabolism of cells. It has also been found very helpful in treating rheumatoid arthritis, although its mechanism of action in this illness is not known. It seems to work, in part, by altering immunity, which may play a role in causing rheumatoid arthritis.
http://www.medicinenet.com/methotrexate/article.htm

People with rheumatoid arthritis (RA) need to maintain a proper balance between rest and exercise. More rest is needed when their disease is active because resting can help reduce joint inflammation and pain while allowing time for a person to recover from fatigue. However, more exercise is appropriate when their disease is less active.But in pregnancy,gentle exercises are needed.In the first trimester,complete rest is prescribed.Then light and moderate exercises are started.

Hope it helps.Take care and regards.

[raj1980]

Hello,
thanku again for ur very helpful information.
I have few more queries.
1.Now the ESR value is 46 -if she stops her methotrexate----will this gt her pain back and increase the ESR value
2.whats the FUNCION of THE METHOTREXATE
3. can exercis IMPROVE RA
thankyou

[Bhupinder Kaur, MD]

Hello,

ESR of 45 is still high.In females ESR in the range of 1-20 mm/hr is considered normal.ESR  should not be taken as a criteria for determining pregnancy.If your daughter wants to conceive,she should only stop taking methtrexate at least 3 months prior to conception and start with folic acid.Also as earlier told,none of the medicines are safe in pregnancy esp 1st trimester because organogenesis takes place in the first trimester and taking of any medicines will effect the development of organs of the baby.Choice of the medicines to be taken in pregnancy will depend on the condition of RA at that time.So it is better to consult her rheumatologist time and again and start or stop her medicines under his supervision as clinical examination is required at regular intervals.

Hope it helps.Take care and pls do keep me posted on how your daughter is doing.

[raj1980]

thanks a lot dear fr provding me so much of informtion.
I really appreciate it and i would be really thankful if u could help me out with these questions toooooo
Right now my daughters ESR IS 45.
1. IIs it a high value of ESR
2. In case if she has to wait how long has she to ait fr conception for normal values of ESR
3.Can she take hydrochloroquine till her conception
4.are there any meds safe enough tht can be taken during pregnancy

her ESR was 80 last month  NOW ITS REDUCED TO 46
plz help me out to do the necessities before sh could get pregnant

thanking u
RAJ1980

[raj1980]

thanks a lot dear fr provding me so much of informtion.
I really appreciate it and i would be really thankful if u could help me out with these questions toooooo
Right now my daughters ESR IS 45.
1. IIs it a high value of ESR
2. In case if she has to wait how long has she to ait fr conception for normal values of ESR
3.Can she take hydrochloroquine till her conception
4.are there any meds safe enough tht can be taken during pregnancy

her ESR was 80 last month  NOW ITS REDUCED TO 46
plz help me out to do the necessities before sh could get pregnant

thanking u
RAJ1980

[Bhupinder Kaur, MD]

Hello,

I will give answer to your queries one by one.

1) Your daughter’s ESR is still in the higher range.Pregnancy is to be avoided in the acive stage of the disease.But if she wants to conceive then she has to inform her rheumatologist so that methotrexate and hydrochloroquine can be stopped and other medicines prescribed.

2) Methotrexate is extremely teratogenic and should be stopped immediately if preganancy is planned. Because the active metabolites have a long half-life, methotrexate must be discontinued 3 months prior to conception; treatment with folic acid should be continued in that period and throughout pregnancy.

Hydrochloroquine is to be given only if it is very much essential. Hydroxychloroquine crosses placenta in humans and is observed in ocular tissues of mice. No real fetal toxicity was found at the dosages used for treatment of connective-tissue diseases (6.5 mg/kg) in clinical trials.

None of the medications used in the treatment of arthritis is absolutely safe during pregnancy. Hence, the decision to use medications should be made after careful assessment of the risks and benefits in consultation with the patient. Pain control through nonmedical management (eg, paraffin baths, decrease in physical activity, splinting, cold packs)or steroids(if utmost necessity is there) is preferred. During the first trimester, most of the drugs should be avoided.
http://www.emedicine.com/med/TOPIC3259.HTM

3)No,RA won’t effect her fetus,In fact RA improves during pregnancy and most women notice a marked decrease in the pain and swelling in their joints during their pregnancy.This is due to hormonal changes in the body during pregnancy.

4)Your daughter can stop these medicines only after shifting to other alternatives which her rheumatologist will prescribe.

5)She should stop methotrexate atleast 3months before conception.She can however take hydrochloroquine sulphate till conception.

Hope it helps.Take care and pls do keep me posted on how your daughter is doing.