Hi,
I am also new to this site and am looking forward to reciving help and advice from other women who are pregnant and suffering RA.
I am 15 weeks and suffered my first hospital admission and diagnosis last December 2004 when I had severe shoulder pain which the Dr drained and confirmed in my bloods RA +. Since then i have had about 15 hospital visits with severe pain in both shoulders, hands, knees and now hips. I am bed bound most days and tend to have 2 good days which are not bed bound out of a week. Pain is always there but able to at least walk and wash.
I am under care of a Consultant but he cannot give me any medication for this illness due to being pregnant. It is killing me and I have had to give up work etc as impossible. I have two children and am finding life with this illness depressing and upsetting. I am 32 and always been healthy except for perncious anemia and underactive thyroid but now feel ugly and about 85!
Hope someone can help me out with some advise??!!!
THANK YOU
((((((((Tallulah)))))))
Gentle hugs! I am so sorry that you are feeling so bad. I would my rheumy and talk to them about getting something to help you get through. You might ask if prednisone would be safe in pregnancy. I know that so many of the drugs we take aren't but be persistent until they get something to help with the pain!
Welcome to the site! We are glad to have you here!
Blessings,
Marcy
Hi Tallulah,Thank you you two for the above messages of hope - which they are ! It is promising when you actually hear from 'real' people that it does get better!
I am not pregnant but I do know about the pain.My freind made me a vibroacoustic pillow that I use on my joints when things get real bad. When I started using it I could not walk I was in a chair it was real bad.Since I have been using my pillow it has got a lot better.I do'nt know if this would help you or not but it might be something to look into.
Bobby
Good Morning...I was concidering becoming Pregnant. I would consult not only your RHEMATOLOGIST on this...But see a Specialist the deals in HIGH RISK Pregnancies. They can and should have you on a Dose of Prednisone to help cover the pain. There are things they can do for you. If you need more info, write to me and I will try to help.
Take care and rest...praying for you.
Roblyn
I forgot to ask, Tell me what types of medicines you were on prior to your conceiving?
I will check with a doctor friend of mine who is an Specialist in OB/GYN field. They maybe able to restore one or two meds once you get further along and taper you off once you are in the 3rd trimester.
Roblyn
I'm sorry to hear you are in so much pain. I've had RA for 11 years. I have two boys (7 and 5) and recently had a baby girl. My RA got pretty bad when I had to go off Enbrel and Celebrex for the pregnancy, but got much...no, MUCH...better after my 1st trimester was over. I was able to stay on 10mg of Prednisone for the whole pregnancy. Do you see a rheumatologist? If not, you really should. I hope you start feeling better soon. A lot of times people with RA go into remission during pregnancy. Usually after the first trimester. Good luck to you!!!!
Molly
ok, i answered a post previously about pregnancy and now that i'm back online, i've done some more checking. this is kinda long, but it is what i've found so far. oh, and never let someone say there isn't anything you can can take during pregnancy. if the benefits outweigh the risks, some meds are considered preferable to others. i had an OB, a rheumy and my son's pediatrician tell me that the breast feeding cunsultant was wrong in saying there was nothing i could take and still breast feed. they all agreed that as in pregnancy, if benefits outweigh the risks, it's possible to medicate in a safer way. sorry this is kinda long. wayney
http://www.emedicine.com/med/topic3259.htm
[note from Waynette: This site also goes into listing various meds. NSAIDs etc. Following is info on corticosteroids only.]
Drug Category: Corticosteroids -- Potent anti-inflammatory agents. Relatively safe in low doses (ie, <20 mg) and no consistent adverse effect on fetal health has been observed. May worsen hypertension, edema, and gestational diabetes in pregnancy.
|
Drug Name |
Prednisone (Deltasone) -- May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Metabolized by placenta and lesser concentrations are available for the fetus. Therefore, preparation preferred. |
|
Adult Dose |
5-20 mg/d |
|
Pediatric Dose |
Not established |
|
Contraindications |
Documented hypersensitivity; viral infection, peptic ulcer disease, hepatic dysfunction, connective tissue infections, and fungal or tubercular skin infections; GI disease |
|
Interactions |
Coadministration with estrogens may decrease clearance; concurrent use with digoxin may cause digitalis toxicity secondary to hypokalemia; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics; may alter levels of warfarin |
|
Pregnancy |
B - Usually safe but benefits must outweigh the risks. |
|
Precautions |
Abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur with glucocorticoid use; high doses may result in growth retardation of fetus; cleft palate has been observed in animals; if used during pregnancy, newborn must be monitored for adrenal suppression and infection |
|
Drug Name |
Methylprednisolone (Medrol, Solu-Medrol) -- Decreases inflammation by suppressing migration of PMN leukocytes and reversing increased capillary permeability. Metabolized by placenta, and lesser concentrations are available for the fetus. Therefore, preparation preferred. |
|
Adult Dose |
5-20 mg/d |
|
Pediatric Dose |
Not established |
|
Contraindications |
Documented hypersensitivity; viral, fungal, or tubercular skin infections |
|
Interactions |
Coadministration with digoxin may increase digitalis toxicity secondary to hypokalemia; estrogens may increase levels; phenobarbital, phenytoin, and rifampin may decrease levels (adjust dose); monitor patients for hypokalemia when taking medication concurrently with diuretics |
|
Pregnancy |
C - Safety for use during pregnancy has not been established. |
|
Precautions |
Hyperglycemia, edema, osteonecrosis, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, growth suppression, myopathy, and infections are possible complications of glucocorticoid use; high doses may result in growth retardation of fetus; cleft palate has been observed in animals; if used during pregnancy, newborn must be monitored for adrenal suppression and infection |
http://www.arthritis.org/conditions/drugguide/pregnancy.asp
http://www.arthritis.co.za/pregnancypage.html
Drug safety in pregnancy
The age of medications – both prescription and over the counter medicines, make it crucial for the patients out there, to know all about the drugs they are prescribed and what they mean regarding both benefit and side effect potential. A simple principle is to avoid drugs unless absolutely necessary, and even then to consult your doctor regarding safety of that drug in pregnancy.
The commonest drugs for rheumatic diseases are the analgesics and the anti-inflammatory agents. Analgesics such as paracetamol are felt to be largely safe in pregnancy and no additional precautions are required. Addition of codeine to the preparations however changes the safety profile. Generally codeine is to be avoided. Anti-inflammatory drugs are not dangerous in early phase of pregnancy, to the fetus. Therefore they can be continued until the pregnancy is confirmed, then we generally discontinue them. In later stages of pregnancy – especially in the last third (trimester) of the pregnancy, they are definitely not advised as they can cause a problem with the fetal vessel anatomy – and also result in a bleeding tendency resulting in greater blood loss at delivery, and risk of fetal hemorrhage. In lactation we generally allow the drugs that are short acting and avoid the long acting drugs. The safety of the COXIB drugs, are not tested in pregnancy. No fetal abnormalities have been described but since they are very new, further information will be required before general advice on their use in pregnancy can be given. Until that time, they should be avoided in pregnancy. Females trying to become pregnant should also probably avoid them, as temporary and short-term effects on ovulation and implantation of the ovum (egg) into the uterus may occur in theory, although not documented in practice. Pregnancy developing whilst taking these medications requires simply to stop the drug, and no additional interventions are required.
Disease modifying drugs are more complicated. The use of these medications, keep arthritis in remission, and withdrawal under normal circumstances results in a flare of disease, usually about three weeks after withdrawal. Pregnancy however itself fortunately maintains remission, and therefore withdrawal of the drugs is not practically a problem. The problem however, is that some drugs have to be withdrawn in anticipation of a pregnancy developing. Methotrexate is a typical example of this. The drug should be withdrawn three months prior to a planning pregnancy. The same applies to immune suppressing drugs such as Cyclophosphamide and Chlorambucil. In addition the Methotrexate as used by the male partner, should also be withdrawn three months before trying to plan a pregnancy. These drugs should be discontinued until after lactation has stopped.
The use of Sulphasalazine has never been associated with fetal abnormality, and a lot of experience is known of the drug during pregnancy and lactation. However we still advice discontinuing the drug in a pregnancy and only using it if absolutely necessary.
Antimalarial therapy such as chloroquine, has not been shown to be unsafe in pregnancy or lactation, but again we recommend only using it if absolutely necessary.
Gold therapy by injection is generally not advised. (There are no reports of fetal malformation, however). Withdrawal at least one month in advance is suggested.
Penicillamine, is not advised in pregnancy, and it is recommended that the drug is withdrawn one month prior to planning pregnancy.
Corticosteroids in pregnancy and lactation, are generally considered safe in low dose. Animal studies showing risk of cleft palate are not shown in humans. They offer the therapy of choice in those pregnant patients who are flaring and cannot take the disease modifying drugs or anti-inflammatory drugs.
Cortisone injections can also be used in pregnancy without problems.
http://www.arthritis.co.za/pregnancy.html
NSAIDS: Salicylates - are toxic to the fetus in high dose in animal studies, but not found to cause congenital malformations. But they cause other problems - anemia, prolonged gestation, prolonged labor, peripartum hemorrhage, haematoma / preterm fetal hemorrhages. They must therefore NOT be used in the last several weeks of pregnancy. They are usable in low dose early in pregnancy. The other commercial NSAIDS - can suppress labor Result in premature closure of the fetal ductus arteriosus - required by the fetal circulation. Must not be used in the last several weeks of pregnancy.
Cortisone - has shown to be relatively safe. There is an increase in cleft palate in animals but this has not been shown in humans. High dose causes growth retardation. This would be considered the second line agent of choice after dispirit. BUT the dose must be low. Local cortisone injections ARE SAFE and may be very effective.
Gold- this crosses the placenta. Is teratogenic in fetal mice - but again not seen in humans. Nevertheless I Wouldn’t use it.
Antimalarials...These cross the placenta and theoretically may cause ear and retinal damage. I Wouldn’t use it.---stop if pregnant. Studies however do not show definite problems and many sources maintain that the drug can be used if absolutely necessary.
Penicillamine --Can penetrate the placenta. Fetal connective tissue problems have been described. I wouldn’t use it
Azathioprine.. Reports of growth retardation are seen. Blood abnormality -lymphopenia is seen in the fetus. Transient chromosomal changes can also occur -- Advise against use
Sulphasalazine - No evidence of damage to the fetus is documented. In fact most information comes from patients with inflammatory bowel disease and little information is available in patients with RA. However there are no reports of problems. Use should be restricted to those patients where it is considered as absolutely necessary.
Methotrexate / Chlorambucil / Cyclophosphamide...Can Cause congenital abnormalities, and are contraindicated. They should be stopped at least 3 months before the pregnancy.. If someone gets pregnant on these - do an ultrasound and amniocentesis, to exclude problems and STOP the drug.
NB People planning pregnancy should plan it with the help of the doctor.
http://arthritis.about.com/od/preg/
Hello! I have had RA for 17 years, and just found out last week that I am pregnant. I've been working w/my rheumatologist while trying to conceive, and while my RA isn't in remission as it would be with Enbrel, it is controlled, well enough most days. I'm guessing that my current fatigue is from the baby, not the RA!
My doctors are fine with me taking prednisone; I was at 12 mg/day, but have tapered to 8 over the past few months. They also added Plaquenil, which was noted as safe above (by generic name, hydroxychloroquine sulfate). I also take Tylenol 4 times/day.
Interestingly, as far as pain control goes, it seems the strongest pain meds are the easiest on the baby. So, I'm taking 20mg Oxycontin twice a day, which helps a lot, and I can take up to 3 vicodin a day for any breakthrough pain.
There is no reason for you to be bedridden by your RA, even if you are pregnant. This is a classic case of the benefits of the meds outweighing any small risk involved. Most of the risk is to you, anyway, not your baby (gest. diabetes from the prednisone is the most likely). If your current rheumatologist does not agree to put you on some sort of treatment plan, get a new one.
Take care, and congratulations!
Heather
Heather,Thank you everyone so much for taking the time to reply to my post - it does help.
I went yesterday desperately to my OB to see if he can help as at the moment i have 5 fingers out of use completely and swollen up like sausages
Anyway - had a moan today !
Hope you are all well
Find a new rheumy. In all honesty your current rhuemy's position is wrong. If he doesn't care about a patient enough to treat a current problem then he doesn't need you as aa patient. I'm sorry to hear you are having problems...many women do go into remission during pregancy at least that's what I have been told. Most I've talked to do have some sort of issue. But, the ones who I know have caring docs who treat their pain, seem to have less problems. I know you are in a rough place. This may sound odd but does your insurance have a helpline to call? Mine does. They have nurses you can speak to and all that. If yours does then I would call them. They may be able to point you in a helpful direction. I know when i was pg, my insurance had a nurse who called me periodically and checked on me. She also told me not to let the docs tell me there is nothing to be done for pain. I also definitely understand your worry about if you feel this bad now how will you be able to do things later.
Gentle Hugs. Hope you can get some relief soon.
Wayney