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Divya from United Arab Emirites asks: I have had two successful pregnancies but have had increasing joint pain, stiffness and swelling after each pregnancy. A CCP antibody test has returned positive. What is going on?
The time after pregnancy is a higher risk period for the development of rheumatoid arthritis (RA). Conversely, rheumatoid arthritis often goes into remission during pregnancy. A positive anti-CCP antibody is usually associated with rheumatoid arthritis as well. It is important to discuss a treatment plan with your physician or rheumatologist to ensure a good outcome, but also safety for you and baby.
Dallas from Edmonton asks: My fiancée and I are getting married in less than a month and we have starting talking about having a family. I’m currently taking Methotrexate injections once a week. We are worried that the methotrexate could increase the chance of birth defects. Has there been any studies done regarding the effects of methotrexate in men when trying to have a baby?
Certainly females should not get pregnant while on methotrexate, with recommendations suggesting that women should stop methotrexate at least 3 months before trying to become pregnant. The data for men is less clear. There are rheumatologists who recommend the same for men, avoidance of methotrexate for at least 3 months before trying to conceive. There are suggestions that methotrexate could affect sperm, however, no study has clearly shown any harmful effects.
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.