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Rheumatoid Arthritis & Pregnancy


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#1 Babushka80

Posted 06 June 2013 - 04:57 PM

Hi

I am new to this forum and wanted some advice.

I am looking to get pregnant soon with my first child.

I am 33 yrs old and was diagnosed with RA at the age of 2. I have had 2 knee replacements and 2 hip replacements. Because of the inflammation in my body i have developed Uveitis in my eyes also and have had glaucoma & cataract surgery in both eyes.

Currently the meds i am on are ... Celebrex 200mg daily, prednesoline 5mg daily, Methotrexate 15mg weekly, folic acid twice a week and predneferine forte(cortisone eye drops) both eyes twice daily.

I have been advised by my Rheumy that i would need to get off the methotrextrate and go onto Plaquenil  and Salazopyrine as they are apparently "safe" during pregnancy. Just reading up on side effects on these drugs and plaq can cause damage to the retina of the eye and blurred vision. I am quite worried about these side effect and how my body will react to these meds and i really dont need anymore issues with my eyes.

Does anyone have any advice on which path i should take according to their experiences? Are these meds Plaquenil and Salazopyrine ok for pregnancy??

Also is cortisone ok during pregnancy?? really? GP says no but Rheumy says yes?

Any information would be very helpful!

Thanks

#2 IVL

Posted 07 June 2013 - 09:01 AM

Hi Babushka,

are you not on any biologics at all? Would you qualify. I know that Enbrel is now considered to be ok to use up until (and even sometimes) during pregnancy see this link

http://bjcconnectedcare.com/2013/03/what-d...iologic-dmards/

I would make an appointment with an OB who specialised in this area and discuss with them. I know that GP's are often quite conservtative (for good reason) when it comes to medication in pregnancy.

I took both these medications as we were considering another pregnancy but they did little to control my RA. In end we opted not to have another baby, easier for us as we already had 2, so we were just being greedy really. I also took predinisone during this time as it kept my inflamation at bay. I do recall having regular eye checks for the plaqunil but did not have any issues, though I never have with my eyes.  

There is a great book by an Australian author Suzie Edward-May called Arthritis, pregnancy and parenting. Well worth the read. You might be one of the lucky 85% that go into remission during pregnancy and will not need any medication at all during this time.

#3 CoffeeRock

Posted 07 June 2013 - 09:42 AM

Hi,
I have had rheumatoid arthritis since I was 18, I'm now 31.  I have one DD and am expecting a second around Christmas time.  Before the first I went off Methotrexate for at least 6 months but it ended up being about 12.  I just happened to have a lull in my disease activity and only needed 10mg of prednisolone which I managed to get down to 5mg during my pregnancy.  My OB is fine with Pred during pregnancy he just put me up to 20mg for nausea as my morning sickness is worse this time.  
Before I tried to get pregnant the first time I went to see my OB for a pre-pregnancy appt, I had some blood tests done for some things like the lupus antibodies that cause clotting problems just to make sure with the RA and we discussed delivery with my hip (I have had a hip replacement).  He was happy with a normal delivery as my Orthopedic surgeon was happy with it.  In the end I booked an elective cesarean as I was too scared I would damage my hip during delivery, my OB was very understanding about that. In the end I ended up with and emergancy cesarean due to pre-eclampsia and delivered five weeks early.  
I would suggest you have a chat with an OB about getting pregnant and see what they say.  I felt a lot better after my pre-pregnancy appt he really put me at ease about what I could take etc, he also was happy to chat to my rheumatologist about things like breast feeding.    
    


#4 FeralLIfeHacker

Posted 07 June 2013 - 04:15 PM

Hi,

just on the plaquenil/eye thing, I've been on Plaquenil for 19 mths, I see the Opthamologist regularly to have the eye health tsted (it's a requisite when on Plaq), he tells me every single time that it is just a precaution and that the chance of Plaquenil affecting the eyes is very, very small and he has never seen any patients affected by it and most of them have been on it for many years.

Rodney Whyte at Monash Uni is an awesome person to contact about drugs while pregnant or breastfeeding, I am breastfeeding still so havent been able to start MTX yet but he told me Pred, Sulfa and Plaq are all fine while breastfeeding, I am sure he'd be able to give you a lot of good info.
I don't think I have his number anymore but I got it from the ladies here in the Breastfeeding section, so if you ask there I am sure someone will have it.

Goodluck

#5 Blueberrymummy

Posted 07 June 2013 - 05:43 PM

Hi OP,

I've had RA since 19, however the symptoms were very mild for a few years and I pretty much ignored them only taking Naproxen. I then became pregnant and went into complete remission however after having DS1, the RA went to every joint and I had a very long and difficult post partum flare. I started MTX and Prednisone but I wasn't happy with that and I ended up searching for an alternative treatment and found Minocycline which is actually considered a DMARD nowadays. The Minocycline put me into full remission and is pretty safe to take while TTC as it is only antibiotics. I then became pregnant with DS2 and stopped the Minocycline. This time I didn't have a pregnancy remission but the pain was less. I just wanted to tell you about the Minocycline in case it might be an option for you. Sorry to read that you have been dealing with this since the age of 2. I am in a bit of a rush as DS2 is waking up but if you want anymore info about Minocycline please read this website http://www.roadback.org/ or PM me anytime.

Edited to also add this link http://community.babycenter.com/groups/a40...atoid_arthritis

Edited by Blueberrymummy, 07 June 2013 - 05:45 PM.


#6 Babushka80

Posted 16 June 2013 - 07:30 PM

Wow what a response everyone! Thank you for all your replies!

IVL- I dont know much about biologicals and i dont know if i even qualify? If i do request to go on them I must then go off them during pregnancy? Can u recommend an OB that specialises in complicated pregnancies? I think i will check out Suzie's book for a bit of light reading.

CoffeeRocks- Great to hear you RA was settled during the begninning of your pregnancy! I too also have anti-bodies that can cause blood clotting which i am worried about. Sounds like you had a pretty good OB! Im looking for one at the moment! Did u go public or private?

Lifehacker - Did u have any other side affects while taking plaq... like stomach upsetness etc?

Blueberrymummy - I hope i am as lucky as you and go into remission!

Did you ladies take out private health insurance ??

Is there special treatment in the public system in  Melbourne for complicated pregnancies?

Thank you so much everyone for your responses original.gif

#7 CoffeeRock

Posted 25 June 2013 - 05:26 PM

Hi,
  My rheumatologist said something about going to the high risk clinic at the Mercy as he has out patient clinics at the Austin, but I wasn't keen on the commute when very pregnant as I'm in Ballarat.  I don't know how you get into the high risk clinic if you get referred once your pregnant or you can book in before hand.  I decided to go Private because I like seeing the same person every time, and used the pre- pregnancy appt as a try before I buy option.  I started with the most highly recommended and he was lovely, but I was prepared to try the others.  I think trust in your OB is important.  
I have private health insurance so opted for the private hospital, which turned out to be a good choice.  Since my DD was early she spent a few weeks in the special care nursery learning how to suck.  At the time the public hospital nursery was full and had I been there we would have been sent somewhere else.  It was hard enough leaving her there but it would have been so much worse not being at home.  
Going private was personal choice but I am sure the public system is just as good.

#8 elizabethany

Posted 25 June 2013 - 09:57 PM

I am another with RA and pregnancy issues.  My Rheumy is conservative with medication, and does not want me on Plaq while pregnant.  Different doctors will have different ideas on this one.  Sulfa makes it more likely to develop Lupus, so if you have any sort of family history or multiple risk factors, don't take it.

If you do go on plaq, you will have regular eye checks, and should stay out of the sun, as that reduces the damage.  Make sure you have some good sunnies original.gif

Biologicals are only an option if you fail a combination of plaq and mtx, so you will probably have to try it at some point anyway.

My RA goes into partial remission during pregnancy, so I only need to take prednisalone, but have plaq and mtx when not.

If you do go private, make sure your OB is familiar with the details of all this.  I went public at the local tertiary hospital, as the consultant OB who I deal with knows my rheumy, so I get very good care.

One last thing, RA often gets worse with each pregnancy, so take this into consideration when family planning.  You are also at higher risk to develop other auto immune problems with each pregnancy.




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