Rheumatoid arthritis and pregnancy

Here are a few tips on rheumatoid arthritis and pregnancy:

Avoid pregnancy when RA is active, especially in the presence of extra-articular symptoms of vasculitis.
Use contraception while taking DMARDs. Consult with your doctor regarding any rheumatoid arthritis and pregnancy issues that might appear.
Breastfeeding may increase the likelihood of arthritis flare-up.
Patients can breastfeed, provided they are not on azathioprine, methotrexate, cyclophosphamide, or cyclosporine. Exercise caution if mothers are on sulfasalazine because this drug is secreted in the milk and adverse effects have been observed in an infant whose mother was a slow acetylator.
Hydroxychloroquine is also secreted in breast milk; therefore, use this drug with caution. Ask your doctor about the interaction of this substance and your fetus – more rheumatoid arthritis and pregnancy information is available in the Bibliography section.
NSAIDs can be used with caution, provided newborns do not have jaundice, because NSAIDs can displace bilirubin and predispose patients to the development of kernicterus.
When recommending treatment during pregnancy, patients must be informed of the potential adverse effects of the drugs on the fetus.

Bibliography

Barrett JH, Brennan P, Fiddler M, Silman A: Breast-feeding and postpartum relapse in women with rheumatoid and inflammatory arthritis. Arthritis Rheum 2000 May; 43(5): 1010-5
Brennan P, Barrett J, Fiddler M, et al: Maternal-fetal HLA incompatibility and the course of inflammatory arthritis during pregnancy. J Rheumatol 2000 Dec; 27(12): 2843-8
Crocker IP, Baker PN, Fletcher J: Neutrophil function in pregnancy and rheumatoid arthritis. Ann Rheum Dis 2000 Jul; 59(7): 555-64
Jorgensen C, Sany J: Modulation of the immune response by the neuro-endocrine axis in rheumatoid arthritis. Clin Exp Rheumatol 1994 Jul-Aug; 12(4): 435-41

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