Which rheumatoid arthritis medicines are safe post-partum?

Question

Hello doctor,

I am a 35-year-old woman living with rheumatoid arthritis for the past five years, and I am currently in my second trimester of pregnancy. My joint pain and stiffness have actually improved during pregnancy, which my rheumatologist said might happen, but I am extremely worried about postpartum care and breastfeeding.

Before pregnancy, I was on Methotrexate and had to stop it when we started trying to conceive, and my symptoms flared terribly during the first trimester. I am also concerned about how I will manage caring for a newborn with my joint limitations, especially during flares. My hands and wrists are particularly affected, and I worry about my ability to hold and care for the baby safely.

Additionally, I have been experiencing some pelvic pain and wondering if this is pregnancy-related or connected to my rheumatoid arthritis. I have a family history of postpartum depression, and I am concerned about how the stress of managing rheumatoid arthritis with a newborn might affect my mental health. My periods were already irregular before pregnancy due to the rheumatoid arthritis medications, and I am wondering about future fertility and family planning options.

Is it safe for me to breastfeed while managing rheumatoid arthritis, and which medications can I resume postpartum?
How can I prepare for caring for a newborn with limited hand and wrist mobility due to my rheumatoid arthritis?
Are there adaptive tools or techniques you would recommend for infant care when dealing with joint stiffness and pain?
Could my pelvic pain be related to my rheumatoid arthritis, or is this normal pregnancy discomfort?
What is the likelihood of my rheumatoid arthritis symptoms returning or worsening after delivery, and how can I prepare for this?
Given my family history of postpartum depression and chronic illness, what mental health support should I seek?
How might my rheumatoid arthritis affect future pregnancies, and what family planning considerations should I keep in mind?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Taking care of a newborn can be quite challenging, and adding the pain and joint stiffness of rheumatoid arthritis (RA) may even make this period more challenging. Some measures can be taken during the postpartum period to help with your symptoms and also ensure that you can safely take care of your baby.

There are some medications you can use postpartum for the management of your symptoms. This, however, depends on whether you choose to breastfeed or not.

If you choose not to breastfeed, you can be commenced back on Methotrexate, as it has been effective for you before, so it will help to prevent flare-ups of symptoms. Methotrexate is not used in breastfeeding mothers.

If you choose to breastfeed, there are quite a number of medications that you can use, ranging from NSAIDs (non-steroidal anti-inflammatory drugs) to low-dose corticosteroids.

You would need to schedule a visit in your late third trimester with your rheumatologist to determine your postpartum management plan, as flare-ups of RA are common during the early postpartum period.

Rheumatoid arthritis (RA) is a risk for venous thromboembolism, and contraceptive choice should be something that does not contain estrogen. So you can use an IUD (intrauterine device), such as a Copper intrauterine device or a Levonorgestrel intrauterine system, or you can use an Etonogestrel implant. This will be effective, and it is particularly important if you are choosing Methotrexate as your postpartum medication.

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

Thank you.