If you have psoriatic arthritis (PsA), a condition that can be hard to diagnose in Black patients, you are probably used to checking in with your doctor on a regular basis. Regular doctor's appointments will be even more important throughout your pregnancy so that you are aware of how to keep you and your unborn child safe. Getting your psoriatic arthritis under control will ensure that your pregnancy is healthy and goes the full term.
Although many women with PsA experience a reprieve from symptoms while they are pregnant, a new study shows that the risk for preterm birth and cesarean delivery are increased for pregnancies among women with psoriatic arthritis, and these risks vary with the presence, timing, and type of antirheumatic treatment, according to a study published online Oct. 20 in Arthritis & Rheumatology.
The researchers found that women with PsA pregnancies were more often obese, more often smokers, and more likely to have a diagnosis of pregestational hypertension, preeclampsia and diabetes compared with women with non-PsA pregnancies. Increased risks in PsA pregnancies were most pronounced for preterm birth and both elective and emergency cesarean delivery compared with non-PsA pregnancies.
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"From a clinical point of view, all women with PsA, regardless of antirheumatic treatment, should be counseled about pregnancy outcomes and receive individualized monitoring during pregnancy," the authors write.
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Symptoms during pregnancy
If your PsA does worsen during your pregnancy, you may experience joint pain and swelling that is aggravated by the weight of your baby. You may also experience pain in your back and spine due to changes caused by your growing belly as well as worsened fatigue.
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What to discuss with your doctor
If you are pregnant or looking to become pregnant, you will need to discuss how your treatment plan may have to change. Some medications that are linked to PsA can cause side effects and have been linked to birth defects. Your rheumatologist and obstetrician should be able to weigh the pros and cons of each medication with you.
Most doctors will reduce the number of PsA medications you are taking and their dosages to tailor them to the needs of you and your growing fetus. Sulfasalazine and cyclosporine are considered safer than other PsA treatments. According to a study, 74% of women who used sulfasalazine during pregnancy did not have an increase in birth defects. Prednisone is also considered safe during pregnancy, but your doctor will need to adjust your dosage depending on the severity of your disease and the trimester you are in.
If you have lower back or severe hip arthritis, you may want to
ask your doctor if a vaginal delivery is possible.
Postpartum
After you have the baby, you may experience your symptoms worsening. Around 75% of women experienced remission (no disease activity) or low disease activity during pregnancy and right after, according to a study.
After about six months of delivery, symptoms increased significantly. If you notice this, you should reach out to your rheumatologist about updating your treatment plan and let them know if you are experiencing any changes in your disease such as back pain and stiffness.
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Your doctor will also be able to develop a treatment plan for after the baby comes, which will be especially essential if you plan to breastfeed.
Your doctor may recommend topical treatments such as creams and low-potency corticosteroids as a first-line of treatment, which are completely safe for both you and your child while breastfeeding. Just be sure to apply the treatments after breastfeeding and remove them before breastfeeding. You should also avoid using them near your nipples so that your baby isn't ingesting them during breastfeedings.
Your rheumatologist and obstetrician are your best sources at developing the best care plan during and after your pregnancy.
However, there are also some measures you can take to make that process much easier:
- Making healthy lifestyle changes. “As much as possible, exercise, eat right, and get plenty of sleep,” Julie Shafer, PhD, a psychologist in Portland, Oregon says. This reduces your vulnerability to stress and raises your emotional resilience, she notes. Be sure to drop bad habits, too, like smoking and drinking too much, Elaine Husni, MD, MPH, a rheumatologist at Cleveland Clinic in Ohio advises.
- Get to your goal weight. Being overweight stresses your joints, and excess fat can cause your medication to not work as well, Husni notes. Obesity also puts you at greater risk for diabetes, heart disease, and other health problems related to psoriatic arthritis.
- Be kind to yourself. It’s essential for improved self-confidence, Shafer shares. “You won’t be able to feel better about yourself if you’re regularly putting yourself down.”
- Lean on others. Ask family and friends for help if you’re struggling, Shafer suggests. “Connect with other people who have psoriatic disease to talk about your experiences living with the condition," she adds. "The validation that comes with knowing you are not alone is a great confidence booster.”
