Rheumatoid Arthritis (RA) is an autoimmune disorder that usually affects women who are of childbearing age. It is a type of inflammatory arthritis. This means that the patient with RA will have pain and swelling in their joints. Although the hands, wrists or elbows are commonly involved, patients can present with such joint problems in virtually any joint of the body. People often assume that joint pain is the only problem to be solved in RA, but this is not the cause. What we need to understand is that RA is a “systemic” disease, just like Diabetes or Hypothyroidism. Joint disease is simply one of the main manifestations of RA, and controlling the disease leads to improvement in all the symptoms and complications.
Among the complications, one should keep in mind the issues arising from patients with RA who become pregnant. An interesting facet of this disease is that the hormone environment in a woman’s body during pregnancy itself leads to an anti-inflammatory state. Women with RA often report feeling better during pregnancy, as the cells and cytokines (molecules released from the cells in the body) involved in RA usually are suppressed by the pregnant state. However, expert, Dr. Sounak Ghosh, Consultant, Department of Rheumatology, CMRI, Kolkata, shares insight on what else can happen to a pregnant woman who has RA. A vital part of maintaining a healthy pregnancy is the adequate functioning of the placenta. The placenta is a barrier formed in the mother’s womb that connects the mother’s blood circulation to that of the developing baby inside, as a result of which the cells and molecules in the mother and baby have a chance to exchange and interact with each other. This is how the developing foetus will extract the necessary nutrition during its growth.
There are various types of antibodies present in the blood of the mother with RA, which will not just affect the mother’s joints but may lead to problems in the mother’s blood vessels as well. Therefore, due to changes in the cells and molecules in the placental blood vessels, we have a lot of evidence that the maintenance of pregnancy in a patient with RA is not the same as that of a healthy mother without this disease. There are several meta-analyses from studies in pregnant women with RA that have now shown that there is an increased risk of mothers with RA having preeclampsia, gestational hypertension or the risk of spontaneous abortion.
So how do we reduce the risk in RA patients planning a pregnancy? Well, the proper control of disease activity before conceiving, proper monitoring of the patient’s blood reports during her pregnancy, as well as the involvement of the Obstetrician in monitoring the foetus throughout pregnancy are all essential in preventing these complications. Mother and child health is a very important index of health for any country, and the aim to lower inflammation in RA will subsequently lead to better outcomes for the mother and child. Lastly, while RA is a disease with a lot of genetic factors involved, a mother with RA doesn't always lead to her child getting the disease.
Being aware of the treatment of RA is based on the concept of knowing what treatment options are available, what medicines are safe to be continued in pregnancy, and the evaluation of RA by a rheumatologist who can guide an expecting mother through these issues. Hopefully, with better options for strict disease control, these issues can be dealt with better now than in the past.
ALSO READ: What is Endometriosis? Know symptoms, treatments and surgical options for chronic pelvic pain
