Management of Rheumatoid Arthritis in Pregnancy

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Rheumatoid arthritis (RA) is one of the immunological diseases causing untoward medical problems by affecting several systems in the body. The females are mostly diagnosed with immunological disorders such as scleroderma, psoriatic arthritis, dermatomyositis and juvenile idiopathic arthritis affecting the joints.

Pathology of Rheumatoid Arthritis (RA) in pregnancy
The female hormones especially serum estradiol, 17-a-hydroxyprogesterone and 11-deoxycortisol usually rise in the blood during pregnancy.

Also, estrogen hormone causes a decline in the stromal cell production of interleukein-1 (IL-1), IL-6 and TNF-alpha that play significant roles in RA. The T cell response is further reduced with progesterone.

Fundamentally, pregnancy in itself results in low production of T-helper cell (Th1)-associated cytokines like IL-1 and interferon-gamma and high production of Th2-associated cytokines like IL-4 and IL-10 which have a beneficial role in RA pathogenesis.

It must be emphasized that the use of corticosteroids during pregnancy are known to provide anti-inflammatory and immunosuppressant actions which could be responsible for the improvement witnessed in most pregnant patients with RA.

However, after delivery, there is a risk of flare -p of RA which is primarily as a result of the reduction in the anti-inflammatory steroid levels and other increased hormones. It has also been revealed in several studies that the high levels of prolactin can also lead to this flare-up.

Effects of RA during pregnancy
It has been established that most women having RA do have a stress free and safe pregnancy with no major complications. Similarly, there is no serious negative impact on the fetus.

However, there may be reduction in sexual drive, dysfunctional production of egg for fertilization and defective hypothalamic-pituitary-adrenal axis that may cause difficulty in conception.

There is usually a reduction in the symptoms of RA in the early stages of pregnancy, but there is growing back pain and edema especially in the feet with high risk of shortage of blood in the third trimester of pregnancy.

Treatment
The management of rheumatic arthritis mainly involves the use of medication. Drugs that can be safely used in pregnant patients with RA include low dosage of aspirin (less than 80mg per day), low dosage of prednisone, hydroxychloroquine with sulfasalazine.

All these drugs are to be prescribed by the medical doctor.