How can I manage rheumatoid arthritis during my pregnancy?

Question

Hello doctor,

I have been managing my rheumatoid arthritis quite well with Methotrexate and Hydroxychloroquine, but I am now planning to try for a baby. I understand that some of these medications may not be safe during pregnancy, but I am afraid of stopping them and triggering a disease flare-up. If I do experience a flare during pregnancy, will there be any safe treatment options available? I want to approach this as safely as possible for the baby, but I also want to avoid becoming non-functional myself. Additionally, how long before trying to conceive should I stop taking Methotrexate?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Methotrexate is contraindicated during pregnancy because it is known to be teratogenic, meaning it can cause birth defects, and it also increases the risk of miscarriage. To ensure it is fully eliminated from the body, it is generally recommended to discontinue Methotrexate at least three months before attempting to conceive.

In contrast, Hydroxychloroquine is typically considered safe to continue during pregnancy and may even help maintain disease control and reduce the likelihood of rheumatoid arthritis (RA) flares. Managing RA during pregnancy is important, as active flares can be harmful to both the mother and the developing baby.

If a flare does occur during pregnancy, there are treatment options considered relatively safe, such as low-dose corticosteroids like Prednisone for short-term inflammation control.

In some cases, biologic drugs, particularly tumor necrosis factor (TNF) inhibitors, may be used, especially during the first and second trimesters, although this decision should be made in close consultation with a rheumatologist. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used cautiously during early pregnancy but are generally avoided in the third trimester due to potential risks.

If you are considering pregnancy, it is essential to discuss your plans with your rheumatologist or healthcare provider as early as possible. Together, you can develop a personalized plan to safely taper off Methotrexate, review and adjust your treatment regimen, and arrange for close monitoring throughout your pregnancy to ensure both maternal and fetal health are well-supported.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.