How can a woman aged 40 plan for pregnancy with arthritis?

Question

Hello doctor,

I am a 40-year-old woman with psoriatic arthritis. The joint pain is manageable right now, but I am worried because I want to stop my biologics before trying to get pregnant. Will stopping the medication cause a flare? Are there any arthritis medications that are safe during pregnancy? Also, my psoriasis gets worse before my period; does that mean hormones are playing a role? No one explains the risks clearly. I also worry about my joints during labor; will they be strong enough? I just want to understand what the safest path is for managing this disease while trying to become a mother.

Please give your suggestions.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your concerns are very valid, and I want to commend you for thinking ahead about managing your psoriatic arthritis while planning for pregnancy. Let us walk through this carefully:

1. Stopping biologics before pregnancy:

Yes, stopping your biologic therapy can increase the risk of disease flare, especially during early pregnancy when hormone shifts may affect immune function. That said, some biologics (like Certolizumab pegol) have been studied more extensively and are considered safer during pregnancy, especially in early stages. It is crucial to work with both your rheumatologist and obstetrician to decide whether continuing a specific treatment is safer than stopping entirely.

2. Arthritis medications and pregnancy safety:

Methotrexate and Leflunomide must be stopped well before conception, as they are not safe during pregnancy. TNF (tumor necrosis factor) inhibitors (like the one you may be on) vary. Some are safer than others during different trimesters. Non-biologic options like Sulfasalazine and low-dose corticosteroids may also be considered under supervision.

3. Hormonal influence on disease activity:

Yes, hormonal changes such as those before your period can impact both psoriasis and joint symptoms. Many women with psoriatic arthritis notice flares around hormonal shifts, including pregnancy and postpartum.

4. Labor and joint strength:

Most women with psoriatic arthritis can safely go through labor. If your hips, spine, or knees are significantly involved, your medical team will monitor and possibly adapt your birth plan. Physical therapy and prenatal strengthening exercises can also help prepare your joints for delivery.

Your safest path forward:

Do not stop your medication suddenly. Discuss tapering or switching to a pregnancy-compatible option with your specialist.
Pre-pregnancy planning with your care team is essential. Consider a referral to a maternal-fetal medicine (MFM) specialist if your arthritis is moderate to severe.
Track your symptoms and menstrual cycle to help predict and manage flares.

You are not alone; many women with psoriatic arthritis have healthy pregnancies with the right guidance. You are doing the right thing by asking these questions now.

I hope this helps.

Thank you.