What are safe RA treatments while trying to conceive?

Question

Hello doctor,

I am 38, and my rheumatoid arthritis has become very difficult to manage since I stopped methotrexate eight months ago while trying to conceive. I am experiencing significant swelling and pain in my hands, wrists, knees, and feet. The morning stiffness lasts three to four hours, and I am struggling with basic activities like walking and holding objects. I have even had to leave my job as a dental hygienist because I can no longer grip instruments.

I have taken Hydroxychloroquine 400 mg daily and Sulfasalazine 2000 mg twice daily; however, my disease continues to be inadequately controlled. In the labs recently done, ESR is 78 mm/h, CRP is 9.8 mg/L, and RF is 245 IU/mL. 20 mg of Prednisone daily helps me, but I know that it is not a drug that should be used for a long time due to conception issues. Additionally, my cycles are irregular (40 to 60 days), AMH is 0.9 ng/mL, and we have been trying to conceive for 18 months without any success.

Could you please advise on pregnancy-safe treatment options for severe RA?
Should I reconsider Methotrexate and pause pregnancy plans?

Please guide.

Thank you.

Answer 1

Hi,

Welcome to iCliniq.com.

I am sincerely sorry you are going through this. Based on your symptoms and laboratory results (attachment removed to protect the patient’s identity), it looks like you have severe, active rheumatoid arthritis, and your distress is reasonable. Poorly managed RA can disrupt menstrual cycles, fertility, and overall quality of life; having good disease control before pregnancy is critical.

Prednisone long-term use and NSAIDs usage are not encouraged for women who want to get pregnant. However, there is hope because there are pregnancy-safe drugs available, which include some biologic drugs that could help treat very severe cases of rheumatoid arthritis when used by professionals. Women tend to recover while pregnant, but relapse after delivery is common.

A low AMH indicates a diminished ovarian reserve, although pregnancy is still feasible. Delaying effective RA treatment may have a greater impact on your chances than using proper pregnancy-safe therapies. Restarting methotrexate would most certainly relieve symptoms but would necessitate delaying pregnancy.

The focus is now on coordinated care between rheumatology and obstetrics to safely control your RA while preserving your fertility prospects.

I hope this addresses your concern.

Please provide comments and let me know if you have any more questions.

I would be pleased to assist you further.

Thank you.