Most reports indicate that pregnancy has a favorable effect on the clinical course of rheumatoid arthritis. Up to 75% of patients experience a significant remission. Furthermore, remission during one pregnancy often indicates that a similar remission may be experienced in a subsequent pregnancy.
Whenever possible, every effort should be made to control arthritic symptoms with adequate rest; physical and occupational therapy; local heat; and, if necessary, intraarticular corticosteroid injections. Gold, antimalarials, nonsteroidal antiinflammatory drugs, and cytotoxic agents should be avoided during pregnancy. Acetominophen and low-dose corticosteroids can be used if needed.
All women with rheumatoid arthritis should be evaluated for significant cervical spine disease, especially subluxation, before delivery. It is advisable to restart antirheumatic therapy shortly after parturition because the disease will flare in the majority of patients within 6 to 9 months postpartum.
Revision date: July 6, 2011
Last revised: by Andrew G. Epstein, M.D.