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Linden from Montreal asks: My wife suffers from rheumatoid arthritis. She normally takes etanercept injections to mitigate the symptoms of her arthritis. She is now breastfeeding and has stopped taking the injections for some time. Her inflammation and pain are getting worse, and we are wondering if it is safe to use etanercept during breastfeeding.

There is limited data about the safety of entanercept or any of the other TNF antagonists during pregnancy and breastfeeding. From the available data, there is no clear indication that TNF antagonists are problematic in pregnancy and breastfeeding. As rheumatoid arthritis goes into remission for many women, and with some uncertainty of safety still present, most women will stop TNF blockers when they know they are pregnant. That said, there are many women who have had successful pregnancies while using TNF antagonists.

For breastfeeding, officially, it is not recommended by the pharmaceutical manufacturers of these medications. However, there is no data to suggest it is harmful to the baby. There is a very small amount of TNF antagonist that is excreted in mother’s milk; it is thought, though, that the medication is broken down in the baby’s gut and therefore is likely not harmful. Ultimately, each individual must balance this small unknown risk and the functional abilities of the mother to care for their newborn if they have active inflammatory arthritis.

Patti from Sherwood Park asks: I have osteoarthritis of my thumb. I have tried NSAIDs and glucosamine, and am thinking about trying Sierra Sil. Any suggestions?

Osteoarthritis to the base of the thumb is a common spot to have osteoarthritis. Treatment is aimed at managing symptoms and improving function. Because of this, treatment options that works well for one person may not be as effective for the someone else. We cover many treatment options on our page for osteoarthritis, but one could consider acetaminophen, NSAIDs, a splint, physiotherapy, topical anti-inflammatories, and/or a cortisone injection, amongst other options. In terms of natural products, please visit our pages on glucosamine, Sierra Sil, and other available natural health products to review them for yourself.

Lorna from Sherwood Park asks: How do I see a rheumatologist?

In Alberta, a rheumatologist sees patients when consulted by another physician. Most commonly, a family physician will feel their patient would benefit from seeing a rheumatologist, particularly if they feel their patient may have inflammatory arthritis or a related rheumatic disease.