Being diagnosed with a lifelong, chronic illness can affect more than just individual life. Being diagnosed at a young age means all long-term decisions must be filtered through new realities. While this is true for anyone, it can be that much more difficult for those that must learn to cope with and manage a lifelong illness like rheumatoid arthritis.
There are physical and medical limitations that individuals diagnosed with rheumatoid arthritis must face after diagnosis. The disease, caused by an overactive immune system that attacks joints and damages ligaments, places individuals in a constant state of discomfort or pain. Medically, individuals with rheumatoid arthritis must maintain regular treatment and therapies which can alter the state of their immune system or change their bodies drastically.
RA and pregnancy
One of the most difficult decisions that must be made in conjunction with an early rheumatoid arthritis diagnosis is whether or not a woman can or should have children. Over half of all women diagnosed report that they had fewer children than they wanted due to their condition, with only a third reporting that they were able to have the full number of children desired before diagnosis.
Having children is considered by many to be one of the greatest joys and experiences that a human being can have in this lifetime. Individuals with rheumatoid arthritis feel like their condition might jeopardize their ability to have or care for children, a concern which in many ways is valid. However, the reality of the situation is that while having rheumatoid arthritis might make it more difficult to bear and raise children, the disease does not make it impossible, and should not deter individuals from pursuing their wishes of having and caring for children.
According to Dr. Megan E. B. Clowse, a rheumatologist at Duke University in Durham, North Carolina, “most women with rheumatoid arthritis are able to conceive and have a successful pregnancy.” Those who experience the best outcomes are able to enter pregnancy with their symptoms under control and are able to maintain reduced symptoms throughout the duration of the pregnancy. With that in mind, here are some common concerns that women have about giving birth and raising children, and the reality of approaching motherhood with rheumatoid arthritis.
Fears about infertility
Fertility is influenced by a variety of factors that may or may not have anything to do with a rheumatoid arthritis diagnosis. The disease itself does not have anything to do with the body’s ability to produce eggs and does not seem to have an obvious impact on the egg’s viability for fertilization. That being said, studies do show that compared to healthy individuals, women with rheumatoid arthritis tend to have more difficulty conceiving.
Age is the primary factor in conceiving. By the time a woman enters her late thirties, fertility is generally in decline. This is true for all women. At a certain point, it becomes progressively less likely that viable eggs will become fertilized. For all women, and especially those with rheumatoid arthritis, it is important not to put off making a decision too long. Though age may not always seem like an immediate factor, having multiple children and timing multiple pregnancies can quickly add up to a number of years.
Those with rheumatoid arthritis do face certain risks in delivery. These risks include premature birth and giving birth to underweight babies, although neither of these risks are particularly life-threatening given enough preparation and precaution. Dr. Clowse recommends fertility treatments to women who attempt for more than 6 months to become pregnant unsuccessfully. Taking fertility treatments is particularly common for women with rheumatoid arthritis.
Passing down rheumatoid arthritis genes
Like most other autoimmune disorders, the cause and means by which rheumatoid arthritis is developed in a person is not clearly understood. There are correlations between individuals who are diagnosed with rheumatoid arthritis who also have close relatives who have had the disease. That being said, rheumatoid arthritis is not a condition that is guaranteed to pass down to a child, it simply makes them more at risk of developing it in their lifetime.
Researchers are working to better understand the way that rheumatoid arthritis is passed down through generations. Numerous genetic risk factors have been identified in people with rheumatoid arthritis. One set of genes in particular, the human leukocyte antigen (HLA) genes, are linked to a greater susceptibility to developing the disease. Some of these genes are passed down directly from the mother, but the genes are not always expressed in children of mothers with rheumatoid arthritis.
As researchers investigate the causes of rheumatoid arthritis, it is become increasingly more evident that there are numerous non-genetic factors that play a role in the development of the disease. Smoking long-term, recent or recurring infections, and hormones may also play a role in development of the disease. With this knowledge, it is more accurate to say that rheumatoid arthritis is the result of both genetic and environmental factors. In reality, Dr. Clowse states that “we don’t see many mother-daughter pairs of people with rheumatoid arthritis.”
Concerns about medications harming babies
Individuals with rheumatoid arthritis are placed on several different prescriptions to control and limit the symptoms of their condition. A lot of prospective mothers express concern that the effects of these medications on their bodies during and after pregnancy might have an effect on their babies. While this is true for certain medications, there are many options which do not have an effect on pregnancy.
Trexall, a commonly prescribed immunosuppressant, is one of the drugs that effects pregnancy. Before conceiving, individuals placed on Trexall will need to go off the drug. There are other classes of prescription medications called tumor necrosis factor inhibitors, or anti-TNF drugs, that are safe for pregnancy and conception. You will need to work with your doctor to determine the safest course of prescription and should aim to have your rheumatoid arthritis under control before undergoing pregnancy.
Providing care to your child
Though all of the above concerns involve pregnancy and the idea of having a child, most mothers also must face the reality of raising a child with rheumatoid arthritis. For those who are set on having a child, there are many precautions that must be taken to ensure that you are physically able to provide care to a baby, even during the inevitable days that symptoms flare up and are particularly difficult to manage.
Most rheumatoid arthritis medications can be taken during pregnancy, or can be resumed shortly after giving birth. With careful attention and management of the disease through medication, sudden increases in symptoms after giving birth should not be a problem. Many women report that their rheumatoid arthritis symptoms decrease during pregnancy as well, which may make it seem tempting to stay off medication. However, the sooner that women resume rheumatoid arthritis treatment, the less likely that symptoms will return.
Dealing with physical limitations requires a little extra forethought and creativity. Most mothers with rheumatoid arthritis keep a second change of diaper materials close at hand and have empty changing tables and surfaces around the house to prevent them from having to bend over or reach the floor. Some days, it will be difficult to even lift a baby, but the key is to continue to find ways to prevent having to stress your joints. Though a little more difficult, motherhood with rheumatoid arthritis is that much more rewarding.