Is it safe for my daughter to get pregnant with active RA?

Question

Hello doctor,

My 26-year-old daughter was diagnosed with rheumatoid arthritis last year, and her symptoms have gotten really bad since she started trying to get pregnant.

Her rheumatologist took her off Methotrexate six months ago because of pregnancy planning, but now her joint pain and swelling are terrible. Both hands are so swollen that she cannot open jars or even button her clothes in the morning. Her periods have also become really painful with cramping that is worse than the RA pain in her joints.

The inflammation markers are high, with CRP at 45 mg/L and ESR at 78 mm/hr, which is much higher than before. She has been having these episodes where her whole body feels feverish, and the joint stiffness lasts all day.

We tried Sulfasalazine, but she gets nauseous and cannot keep food down. She really wants to get pregnant, but the RA is making her life miserable, and I am afraid pregnancy will make everything worse.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query, and I completely understand your concern.

It sounds like your daughter is going through a really tough time right now. The joint swelling, pain, and high inflammation markers such as ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) show that her RA (rheumatoid arthritis, a chronic autoimmune disease where the immune system attacks joint linings, causing symmetric pain, stiffness, and swelling, primarily in the hands and wrists) is quite active, especially after stopping Methotrexate.

About pregnancy, you are right to be cautious. Methotrexate must be stopped before conceiving, but other options can help keep her RA under control safely. Medications like Cimzia (Certolizumab) are often used because they do not cross the placenta much. Hydroxychloroquine is another option that is generally considered safe.

Some women do notice improvement in RA during pregnancy, but ideally, her disease should be well-controlled before conception to reduce risks for both her and the baby.

Here is what you can do next:

You must take her to a rheumatologist soon to discuss pregnancy-safe treatment options.
Controlling inflammation will help her feel better, regain function, and move forward with her plans.
You are a very supportive parent, and it is important to remember that RA can be managed, even while planning for pregnancy.

Also, getting a review in two to four weeks after starting any new treatment is ideal.

I hope this answers your query.

Please feel free to reach out with updates or questions along the way.

Thank you.