Rheumatoid arthritis and pregnancy
Rheumatoid arthritis is a disease characterized by complex autoimmune pathogenesis. The disease usually affects small joints. The cause of the disease has not yet been identified, but there is an assumption that rheumatoid arthritis is a hereditary disease that causes a violation in the immune system. About 70% of patients get disability quite early. Pregnancy with the development of rheumatoid arthritis is difficult. During this pregnancy, the woman should be observed by a rheumatologist. The specialist is likely to cancel or reduce the dosage of medication. According to statistics, the course of the disease in women in an interesting position is much improved.
Rheumatoid arthritis after childbirth
After the first trimester, a pregnant woman may notice a decrease in the subjective and objective signs of the disease. Only in some cases, experts observe deterioration. However, rheumatoid arthritis is insidious because the course of the disease worsens after giving birth.
For women suffering from this disease, pregnancy is a big problem due to the activation of the disease after childbirth. In addition, taking care of the baby requires no small effort, which negatively affects the sick mother.
To give birth or not to give birth to a woman with rheumatoid arthritis, no one can say. It is up to her to decide whether to take this serious step or not. Making this decision depends on several factors, namely:
- from clinical and laboratory parameters;
- on the severity of arthritis;
- from the complexity of functional disorders;
- from close people willing to support the future mom;
- However, the entire burden of responsibility falls on the shoulders of a woman, so it is up to her to decide whether to give life to a new little man.
Problems during pregnancy
The main problem in conceiving and further bearing a child is the necessary intake of antirheumatic drugs. During pregnancy, experts prescribe a woman a small dose of corticosteroids, which do not threaten the fetus. As for the main, more aggressive treatment for the fetus, it stops completely. After giving birth, specialists prescribe a less intensive treatment.
During rheumatoid arthritis, a pregnant woman should be under the close supervision of specialists. An obstetrician-gynecologist and a rheumatologist are responsible for the expectant mother and her child, therefore, should conduct regular check-ups. A rheumatologist should examine a pregnant woman at least once a month. If a relapse is suspected, medical intervention may be required.
Pathology control rules
A woman who has decided to become pregnant, despite future difficulties, must take into account the main factors arising from rheumatoid arthritis. These include:
- no need to wait for remission;
- before planning pregnancy and before conception, it is necessary to cancel medicines that can adversely affect the course of pregnancy and the fetus, these include methotrexate;
- hormonal changes occurring in the body of a woman during pregnancy, as a rule, lead to an improvement in the course of the disease;
- To date, there are no accurate statistical indicators that would suggest the transmission of rheumatoid arthritis, but this risk does exist.
Manifestations of the disease
As mentioned above, the acute course of the disease sharply occurs during pregnancy. The previously expressed arthritis activity subsides. Sometimes a pregnant woman can observe symptoms such as changes in the skin in the form of nodules or erythema and isolated organ damage.
Most pregnant women have prolonged rheumatic heart disease with minimal symptoms. In this case, the expectant mother observes such symptoms as:
Rheumatoid arthritis and pregnancy
Bearing unborn child? crucial moment for every woman. The most difficult thing is when the expectant mother has a chronic illness and there is a serious threat to the fetus. Is rheumatoid arthritis and pregnancy compatible?
Before making a responsible decision about the birth of a new life, it is important to consult a doctor if you know about your disease. For this you need to do clinical and laboratory studies, to establish the degree of development of rheumatoid arthritis, to study the functional disorders of the body. The doctor may first predict whether the risk of disease progression is high and how this will affect the health of the child in the future. It is important to have a great desire to become a mother, care and support of loved ones.
No one can accurately predict how the disease will develop. Rheumatoid arthritis is an autoimmune disease in which small joints are damaged first, become immobilized over time, and health condition worsens. In pregnant women, it can progress dramatically, as medical drugs are stopped or only the most benign are taken. Or does not appear at all (remission), the body of the future mother is fully restored. There is a risk that after birth the disease will begin to progress at lightning speed. It is important every month to be examined by a doctor during pregnancy and after.
If the early stage is established in the diagnosis of the disease, then planning is still allowed, it is strictly prohibited in the later stages. My patients use a proven tool, through which you can get rid of pain in 2 weeks without much effort.
Experience 29 years. Engaged in the diagnosis and treatment of diseases of the musculoskeletal system.
Savchenko Andrey Vasilyevich
A pregnant woman must change the course of treatment for rheumatoid arthritis. The doctor chooses an individual approach. Salicylates and corticosteroids are included in this list of use, as they do not pose a threat to the fetus.
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With the development of this disease, the future mother may have changes in the skin in the form of nodules, and the internal organs are affected. There is shortness of breath, heart murmur (systolic), palpitations, hypotension.
In the diagnosis of rheumatoid arthritis in pregnant women, they are constantly examined, put on save for such weeks of fetal development:
- 8-10 (decide on further pregnancy or its termination);
- 26-36 (large load on the cardiovascular system, prevention);
- 36-37 (preparation for childbirth).
If the future mother’s condition worsens with this diagnosis, she is hospitalized, regardless of the timing:
- strong toxicosis develops;
- exacerbation of the disease;
- disruption of any of the organs.
Becoming a mom with this diagnosis is possible. The main thing ? with the doctor to develop the right treatment complex, which will not affect the baby. It is important during pregnancy to observe proper nutrition, to engage in special physical exercises. After childbirth, you need to constantly inspect the child, since rheumatoid arthritis is hereditarily transmitted. One hundred percent claim that this is so, no one with doctors will not, but do not deny this fact.
What to do if there is no opportunity to constantly consult with experts and receive support from loved ones? An alternative solution is rheumatoid arthritis and pregnancy forum. Here you can ask different questions on this topic. Get a lot of different information, learn about the experiences of others. Each one is different:
- Someone had a normal pregnancy, they took homeopathic medicines while feeding, and everything was fine;
- someone can not decide how to become a mother with this diagnosis and asks others;
- someone simply paints a completely gentle course of treatment for the period of bearing a child.
Listen to the opinions of specialists and those people who have great experience in this, and most importantly – to your heart, believe in the best. Rheumatoid arthritis is not a hindrance to becoming a mom.
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You have to decide, of course, the woman herself. And the decisive factor will be her desire to have a child. If she decides to do this, then the rheumatologist and obstetrician-gynecologist should help her to develop a strategy for further behavior. A woman needs to switch to a sparing treatment regimen. The drugs taken by her should not interfere with the development of the fetus in the womb and the process of delivery.
When planning conception you need to consider the following points:
- wait for remission is not worth it;
- for six months or at least three months, all drugs that may affect the conception and development of the fetus must be canceled;
- hormonal changes during pregnancy lead to a decrease in the manifestations of rheumatoid arthritis, the patient feels much better, sometimes the exacerbations completely disappear;
- there is a risk of inheriting rheumatoid arthritis.
The course of pregnancy in rheumatoid arthritis
A pregnant woman will have to be under the supervision of a rheumatologist all the time, since the dosage of the drugs will be reduced or the drugs will be canceled altogether. In eighty cases out of a hundred, the course of rheumatoid arthritis improves with the onset of pregnancy. By the end of the first trimester, the woman is feeling much better. Objective signs of pathology are also reduced. But rheumatoid arthritis after childbirth can worsen.
Plan to conceive a woman cancel antirheumatic drugs. Treatment continues with salicylates or corticosteroids in small doses. After pregnancy, a woman needs to visit a rheumatologist every three to four weeks, at least. In case of exacerbations, medical care may be needed. In particular, the blockade.
Pain can also be removed with the help of physiotherapy, massage and other similar methods that are not dangerous for the development of the fetus.
The course of rheumatoid arthritis after childbirth
After birth, the disease is activated. A woman has to take care of the baby, often carrying it on her arms, which increases the load on the joints. The course of rheumatoid arthritis is aggravated by the fact that during lactation a woman cannot return to classical therapy.
To control the activity of the disease will again have sparing methods. Some mothers turn to homeopaths for help. Experts select drugs to reduce pain. Homeopathic remedies act, but not as quickly as synthetic drugs. If a woman wants to breastfeed, you have to be patient.
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Rheumatoid arthritis (RA) is a chronic systemic connective tissue disease with progressive damage to predominantly peripheral (synovial) joints of the erosive-destructive type of arthritis with the rapid development of functional disorders in them.
The etiology of RA has not been established, there are many factors that can be regarded as predisposing to RA: sex, age, family, endocrine, metabolic, socio-economic, infectious (streptococcus group B, mycoplasma and especially Epstein-Barr virus). In the development of the disease, genetic predisposition to RA is also important, which causes an increased incidence of the disease among the relatives of patients.
The basis of the pathogenesis of RA is a violation of humoral immunity – hyperproduction of autoantibodies to various types of collagen, including those found in cartilage. Special importance is attached to the presence of rheumatoid factors, which are antibodies to IgG Fc-fragments, since tissue damage in RA is associated with their presence.
The most studied mechanisms of the main manifestation of RA – synovitis. The hypothetical etiological factor damages the cells of the synovial membrane of the joint, which leads to the development of cell proliferation, pannus, bone erosion and the characteristic clinical signs of chronic progressive arthritis.
The pathogenesis of the majority of extra-articular (systemic) manifestations of RA is associated with the development of immunocomplex vasculitis, and also, possibly, with direct tissue damage by sensitized lymphocytes or autoantibodies.
The basis of the clinical picture of RA is articular syndrome. The rheumatoid process is localized mainly in the peripheral joints in the form of symmetrical arthritis of the extremities and is often accompanied by damage to the periarticular tissues (ligaments, bags and joint capsules, tendons and muscles). The articular process is recurrent and progressive. With each subsequent exacerbation, new joints are involved in the process, as a result of which one joint is in an earlier and other in a later stage of the lesion. In RA, the internal organs (lungs, heart, blood vessels, kidneys, nervous system), as well as eyes, skin, etc. can be affected.
In the diagnosis of RA, the criteria of the American Rheumatological Association (revised 1987), including 7 signs, are widespread:
1) morning stiffness for 1 hour. in the last 6 weeks; 2) swelling of 3 or more joints for 6 weeks .; 3) swelling of the wrists, metacarpophalangeal and proximal interphalangeal joints for 6 weeks. and more; 4) symmetry of the swelling of the joints; 5) the presence of subcutaneous rheumatoid nodules; 6) detection of rheumatoid factor in serum; 7) typical radiological changes of the joints of the hands (erosion, periarticular osteoporosis).
Having at least four of the seven criteria allows you to diagnose RA.
As with most rheumatic diseases, RA is predominantly female; the ratio of male and female patients with RA is 1: 3-5 (which is less than with SLE, where the ratio is 1: 8-9). The average age of onset for women is 40.8 years, which is one of the reasons why RA is less important in obstetric practice than SLE.
The effect of pregnancy on rheumatoid arthritis A study of the effect of pregnancy on RA has shown that pregnancy in patients with RA contributes to the development of remission of the disease, which occurs in 54-95% of cases (on average, 77% of patients). Clinical improvement is noted already during the first three months of pregnancy and throughout the gestational period. This not only reduces the effects of arthritis, pain and stiffness in the joints, but also improves other clinical parameters that reflect the activity of the disease. Improving the course of the disease in pregnancy is associated both with changes in the immunological status and with hormonal changes (the formation of a number of specific factors related to pregnancy, an increase in the levels of various hormones) in the pregnant woman’s body.
The absence of remission and the deterioration of the course of RA in the gestational period can be expected in patients with severe disease with severe systemic manifestations of the disease (lesion of the lungs, kidneys, heart, etc.). With the termination of pregnancy, 80% of patients during the first 3 months have a relapse of RA in activity similar to that before gestation. A similar trend in the activity of RA can be traced during subsequent pregnancies of the patient.
The effect of rheumatoid arthritis on pregnancy and the fetus. In patients with RA, subfertility often develops, which is explained mainly by the disease itself.
The cause of the complicated course of pregnancy can be high RA activity during gestation, which required "aggressive" therapy, which, in turn, may have a negative impact on the development of gestation and childbirth. Adverse pregnancy outcomes can also be observed in patients with RA seropositive for antiphospholipid antibodies and / or Ro / La antibodies, with which (as previously indicated) the formation of secondary antiphospholipid syndrome and Sjogren syndrome is associated. Complications of gestation in this case are similar to those examined in pregnant women with SLE (see above).
There is no doubt, however, that in the absence of RA activity during pregnancy, cases of urgent uncomplicated labor with the birth of a healthy full-term baby are frequent.
Obstetric and therapeutic tactics
1. Pregnancy in women with RA is possible with low disease activity. 2. Contraindications for pregnancy in RA are high disease activity with systemic lesions (kidneys, lungs, heart and signs of their functional insufficiency), amyloidosis of the kidneys. A relative contraindication is aseptic necrosis of the femoral heads. 3. Clinical observation provides for the allocation of pregnant women at risk with RA and concomitant APS, as well as with Sjogren syndrome (the latter due to an increased risk of neonatal complications). Examination of a pregnant woman with RA by a rheumatologist is carried out at least once in each trimester, after delivery, and 2-3 months after delivery. 4. In case of stable remission of the disease during pregnancy, it is possible to reduce the dose of the drugs taken and their temporary cancellation until the end of gestation. 5. The terms of hospitalization in the maternity hospital are determined jointly by the obstetrician and the therapist (rheumatologist). 6. Indication for delivery by Cesarean section may be the presence of lesions of the hip joints with impaired function. 7. The method of choice of contraception in a patient with RA may be the use of oral contraceptives, due to the established fact that the use of contraceptive hormonal drugs by women reduces the incidence of RA by 2 times, and in a patient with RA, the disease is in remission. To prevent pregnancy, it is possible to use both mechanical barrier and intrauterine devices.
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