Rheumatoid arthritis (RA) is an autoimmune disease that causes degeneration of the joints. This disease usually manifests with joint pain while resting, muscle stiffness and tiredness, etc.
Although the causes of rheumatoid arthritis are not known, it is thought that a combination of environmental, genetic and endocrine factors could lead to its onset.
Patients diagnosed with rheumatoid arthritis can have a baby, but they will need to consult with their rheumatology specialist. It is also likely that some medications will be withdrawn because of the possible effects they could have on the fetus.
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What is rheumatoid arthritis?
Rheumatoid arthritis is a chronic autoimmune disease that attacks the joints. The exact cause of rheumatoid arthritis is not known, although there are suspicions that some infections could trigger the disease.
The disease itself is characterized by an exaggerated response to certain proteins in the joints, causing inflammation. A slow and progressive degeneration of parts of the joints occurs as a consequence of RA.
Risk factors for rheumatoid arthritis
As we previously mentioned, the exact cause of rheumatoid arthritis is unknown. However, there are some factors that increase the risk of developing this autoimmune disease:
- Age: this disease can appear at any time in life, but is more frequent as age increases.
- Gender: rheumatoid arthritis is more common among women.
- Family history: it is not a hereditary pathology, but if a family member has been diagnosed with rheumatoid arthritis there is a greater risk of the disease.
Furthermore, factors such as smoking, obesity or gum disease have also been linked to an increased risk of suffering rheumatoid arthritis.
What are the symptoms?
In rheumatoid arthritis, the patient's own immune system attacks the joint tissues. In some cases, this joint damage progresses slowly, but if the correct treatment is not given, or if treatment is not effective, rheumatoid arthritis can get worse. The most common symptoms of this disease are the following:
- Pain in the joints, even when resting.
- Joint stiffness.
- Decreased joint mobility.
- Sporadic fevers.
- Tingling, or pins and needles in the hands or feet.
Although rheumatoid arthritis mainly affects the joints, the disease can also damage other organs such as the heart, lungs or kidneys. In addition, some patients diagnosed with RA report having unusual tiredness and a loss of appetite. For these reasons, rheumatoid arthritis is considered to be a systemic or generalized pathology.
Treatment of rheumatoid arthritis
There is no cure for rheumatoid arthritis, but certain medications can help to alleviate the symptoms and therefore improve the patient´s quality of life. In addition, drug treatment can reduce inflammation in the joints and delay, or even avoid, the resulting tissue damage.
Listed here below are some of the most common therapeutic options:
- Medications
- treatment with drugs is usually essential for the majority of patients with RA. At first, the specialist will recommend anti-inflammatory drugs and low doses of cortisone. However, upon a diagnosis of RA, the physician will prescribe a disease-modifying antirheumatic drug (DMARD). This treatment is designed to reduce pain and inflammation, but also to prevent damage to the joint tissues. Amongst the most commonly used DMARDs are methotrexate, leflunomide, sulfasalazine and hydroxychloroquine.
- Physiotherapy
- this therapeutic option eases muscle stiffness. Physical therapy exercises also help to increase joint flexibility.
- Surgery
- in exceptional cases and in patients with a long history of RA, joint replacement surgery can be performed, that is to say, the joints or parts of the damaged joint are removed and replaced by a prosthestic, artificial joint.
For those patients who do not have an adequate response to any treatment, another alternative is targeted therapy. This is a treatment option that consists of blocking the substances related to inflammation.
Ultimately, it is essential to rest and support the joints. For example, the use of wrist supports can improve the well-being of the RA patient.
Rheumatoid arthritis and pregnancy
The chances of having a baby for a woman that has been diagnosed with rheumatoid arthritis are similar to that of a healthy woman.
However, there are studies indicating that women with rheumatoid arthritis are at increased risk of cesarean delivery and low birth weight.
Effect of medication
Experts advise pregnant women suffering from rheumatoid arthritis to consult with specialists when taking medication to treat the disease. Some of the drugs used can cause congenital malformations in the fetus, so it would be advisable to stop taking the medication 3-6 months before pregnancy.
These drugs can be substituted by others, such as hydroxychloroquine, salazopyrin and prednisone, which work to ease the symptoms and discomfort caused by the disease without exposing the fetus to any risk. In this way, the possibility of fetal anomalies can be avoided.
Accordingly, experts advise that the best time for a woman suffering from RA to become pregnant is when the disease is under control. During pregnancy, most patients do not experience any negative changes in the disease, since the state of immune tolerance experienced while pregnant seems to control the evolution of rheumatoid arthritis.
Recommendations before pregnancy
When you are trying for a baby, the first thing to do is to consult with a specialist to find out the best way to proceed. It is of vital importance to stop any rheumatoid arthritis medications that should be avoided during pregnancy. For example, drugs such as sulfasalazine, cyclophosphamide or methotrexate should be stopped before becoming pregnant. In addition, it is necessary to wait at least 3 months after stopping the drug treatment, to avoid malformations in the fetus.
Additionally, the expectant mother could do exercises such as yoga or pilates. This will also help the patient to be relax.
For patients who have to turn to assisted reproduction to have a baby, it is important to carry out a good fertility study and adapt the treatment with the aim of achieving the highest probability of success.
FAQs from users
Does a cure exist for autoimmune diseases?
No. All autoimmune diseases are chronic, meaning they are there for life. Treatments for autoimmune diseases don´t provide a cure, but aim to improve the patients´s quality of life.
These treatments also serve to prevent possible future flare-ups or relapses of the disease.
Do the symptoms of rheumatoid athritis worsen in pregnancy?
Probably not. Patients with rheumatoid arthritis who become pregnant do not usually have any more symptoms of RA during gestation. This is due to changes in the immunological profile that occur during pregnancy.
However, once the baby is born, the rheumatoid arthritis can get worse. As such, specialist control is of vital importance, to try to avoid a possible flare up of the disease.
Should women with rheumatoid athritis undergo fertility preservation?
When giving advice in medicine, we must always individualize each case and bear in mind the various factors, above all because this illness is usually diagnosed more frequently in women, often of a reproductive age, and usually creates doubts and fears with respect to maternity.
The fundamental message to get across to women who suffer from this chronic autoimmune disease, is that if they wish, they can become mothers. Arthritis does not cause infertility nor reduces the likelyhood of falling pregnant; however, it can influence the decision of using certain drugs to control the disease, namely those which can affect the baby if she becomes pregnant during, or in the months following, treatment with the medication.
As such, it is very important for these women to receive multidisciplinary management, with rheumatologists, obstetricians, neonatologists and experts in assisted reproduction to have a global focus on the illness while considering the control of the patient´s symptoms, her quality of life and her desire to become a mother. If the use of gonadotoxins is deemed necessary, which can affect the quality and quantity of egg cells, reducing the ovarian reserve, and / or when we recommend delaying motherhood, vitrifying eggs beforehand, thus preserving fertility, will increase the chances of achieving a healthy pregnancy in the future.
Is rheumatoid arthritis related to male infertility?
There are no conclusive studies about the relationship between rheumatoid arthritis and male infertility. Nonetheless, some medications may result in subfertility in men. For this reason it is advisable for a patient to visit a clinic for a semen analysis if pregnancy has not been achieved after a period of trying.
Is rheumatoid arthritis a hereditary illness?
Rheumatoid arthritis (RA) is not an inherited disease, and it is not contagious.
However, there does seem to exist a predisposition to develop this disease when there is a family history.
Recommended reading
If you want to learn more about autoimmune diseases, you can read this article: Autoimmune diseases: how do they affect fertility and pregnancy?
Furthermore, some drugs used in the treatment of rheumatoid arthritis may cause damage to the fetus and result in miscarriage. For more information on this, you can visit the following link: What is a miscarriage: symptoms, causes and consequences.
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References
Alijotas-Reig J, Esteve-Valverde E. Pregnancy and autoimmune diseases. Med Clin (Barc). 2017 Feb 23;148(4):161-163. Best Pract Res Clin Obstet Gynaecol. 2019 Oct;60:66-76. doi: 10.1016/j.bpobgyn.2019.03.003
De Carolis S, Moresi S, Rizzo F, Monteleone G, Tabacco S, Salvi S, Garufi C, Lanzone A. Autoimmunity in obstetrics and autoimmune diseases in pregnancy.
Panaitescu AM, Nicolaides K. Maternal autoimmune disorders and fetal defects. J Matern Fetal Neonatal Med. 2018 Jul;31(13):1798-1806.
Somers E. Pregnancy and autoimmune diseases. Best Pract Res Clin Obstet Gynaecol. 2020 Apr;64:3-10. doi: 10.1016/j.bpobgyn.2019.11.004.
FAQs from users: 'Does a cure exist for autoimmune diseases?', 'Do the symptoms of rheumatoid athritis worsen in pregnancy?', 'Should women with rheumatoid athritis undergo fertility preservation?', 'Is rheumatoid arthritis related to male infertility?' and 'Is rheumatoid arthritis a hereditary illness?'.
Authors and contributors
More information about Michelle Lorraine Embleton
Hi. I will be 40 in a few weeks and I have RA. I´d really love to become a mom, but I am so scared that it will hurt! My OB/GYN has told me not to worry and that it will be fine… but what I am not? Can anyone tell me their experience? It would be great to hear from some of you who have been through this. Thank you!
Hi Jessicajackie
When a woman becomes pregnant, the symptoms of autoimmine diseases, rheumatoid arthritis included, usually improve. This means it is unlikely that you will have a flare up during your pregnancy.
However, you may have to stop your medication for a while before you try for a baby, as some medications can cause abnormalities in fetal development.
I hope this helps!