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Managing and Treating Psoriatic Arthritis During Pregnancy

Posted on March 02, 2022
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Bethany J. Sanstrum, Ph.D.

Psoriatic arthritis (PsA) can cause challenges during pregnancy. One study found that women with psoriasis are almost twice as likely to experience a poor birth outcome such as preterm birth or low birth weight. If you are considering pregnancy, talk to your rheumatologist. During this preconception phase, your doctor can help you come up with a plan that will help you manage your condition and have a healthy pregnancy.

Pregnancy and Psoriatic Arthritis Treatment

Managing your PsA and medications can be difficult while you are pregnant or trying to conceive. One MyPsoriasisTeam member posted, “It is just a tricky situation since I am trying to get pregnant. I’m not allowed to use all of the biologics right now.”

Your doctor will discuss with you which medications can be continued during pregnancy and which are unsafe. If the drugs you are taking are currently controlling your symptoms and will not harm the baby, your doctor will probably not change them. Over-the-counter topicals for mild psoriasis are likely safe, but it’s important to mention those to your doctor as well.

Methotrexate

Methotrexate is not recommended for use during pregnancy because it can cause miscarriages or harm to the fetus. Your doctor will recommend you stop treatment at least 12 weeks before trying to become pregnant. Once the medication is stopped, there is little to no risk to the fetus, and there are no negative effects on the long-term potential to become pregnant.

Biologics

Biologics are a common treatment option for people with PsA. Ideally, these treatments should be stopped before pregnancy, but in some cases, this is not realistic. Your rheumatologist will discuss the best treatment option for you. Fortunately, small studies have shown that biologics do not increase the risk of birth defects or low birth weight in pregnant women.

Biologics that treat PsA are mainly antibodies, similar to those made by the body’s immune system. Only one specific type of antibody, known as IgG, can cross the placenta and travel from mother to fetus.

In the first two trimesters of pregnancy, antibody levels in the fetus are low, but they will increase during the last trimester. In this case, some medications are better given early in pregnancy, and others are better in the later stages.

Anti-tumor necrosis factor-alpha biologics are the most researched biologics for use in pregnant women. Generally, they are considered safe to use early in pregnancy because of low antibody levels in the fetus. It is recommended that treatment stops between weeks 22 to 24 in pregnancy but can continue to week 30 if needed.

Humira (adalimumab) and Remicade (infliximab) are made using IgG antibodies, which means they can pass to the fetus. Enbrel (etanercept) and Cimzia (certolizumab) are similar in structure to the IgG antibody, but they are different enough that they do not cross the placenta as much. Enbrel and Cimzia are better given during the later stages of pregnancy. Studies have also shown that these biologics can be continued during breastfeeding.

Retinoids

Retinoids are compounds derived from vitamin A, which are commonly used to treat skin conditions like psoriasis. However, these medications have a high risk of causing birth defects and should be stopped before trying to conceive. These include:

  • Absorica (isotretinoin)
  • Soriatane (acitretin)
  • Tazorac (tazarotene)

Topical Treatments

Topical treatments, such as steroids, should be used sparingly. Many of these medications have not been studied for their safety in pregnant women. Be careful when applying topicals to the breasts, as they may pass to the infant during breastfeeding.

Managing PsA During Pregnancy

Symptom control can often change during and after pregnancy. The degree of this change varies greatly between each person. Changes to your symptoms should be promptly discussed with your rheumatologist whether they are positive or negative.

Most pregnant women do not experience worsening symptoms or higher disease activity during or after their pregnancies. One MyPsoriasisTeam member posted, “Mine went away completely while I was pregnant!” But a second said, “Mine was opposite. I have been pregnant four times, and every time, my skin flared up a lot.” Another member commented, “When I was pregnant, my psoriasis disappeared, and I had no problems with my arthritis. So, it’s different for everyone. Talk to your doctor about it, go for it, and see what happens. Good luck.”

There is an increased risk for changes to your disease (or types of flare-ups) during gestation and after delivery because of medication and hormonal changes. One member stated, “My psoriasis went [away] completely when I was pregnant but came back very quickly after.” This may be caused by fatigue or other postpartum period symptoms. Symptoms should be closely monitored by you and your doctor.

If you experience back or joint pain as a PsA symptom, childbearing may increase this pain as the baby grows and adds weight to these areas. General aches and pains from PsA are often increased during pregnancy. This pain also leads to higher levels of fatigue and tiredness during pregnancy. Discuss these symptoms with your obstetrician.

Delivery

PsA typically does not affect a mother’s ability to experience a vaginal birth. This is only complicated if arthritic pain is worsened in the hip or pelvis region. Also, inflammatory arthritis could complicate a vaginal delivery or make giving an epidural difficult.

Trauma to the skin during birth is common. A C-section creates openings in the skin that can take time to heal. There is an association between psoriasis and trauma known as the Koebner phenomenon.

Postpartum

Arthritis and psoriasis disease activity worsens at higher rates after birth when compared to during pregnancy. Pregnant women reported more severe arthritis symptoms 33 percent to 50 percent of the time after delivery. These symptoms were reported only 15 percent to 22 percent of the time during pregnancy. A similar trend was noted with psoriasis treatment. Of the mothers surveyed, 27 percent to 34 percent reported more severe symptoms after birth, and less than 6 percent felt that their symptoms were worse during pregnancy.

Keep in contact with your doctor before, during, and after pregnancy. Disease flare-ups are possible up to nine months after delivery. Take time to care for yourself.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis. On MyPsoriasisTeam, more than 103,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Are you living with psoriasis? Do you have experience with arthritis and pregnancy? Share your story in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Bethany J. Sanstrum, Ph.D. holds a doctorate in cell and molecular biology with a specialization in neuroscience from the University of Hawaii at Manoa. Learn more about her here.

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