Congratulations, you’re pregnant! You’ll now be faced with a host of bodily changes for which friends and family can explain and help you prepare.
But if you’re also living with psoriatic arthritis (PsA), you’re probably wondering what will happen with that aspect of your health. Will the joint pain, swelling, and fatigue subside or get worse? Will you have more flare-ups or fewer? How safe is it to take your usual PsA medicines during pregnancy?
A 2018 study conducted in Norway found that 75 percent of pregnant women saw their disease go into remission or experienced fewer symptoms, particularly during the third trimester.1Mental health was stable or improved up to six weeks after delivery.
The 103 women studied had seven prenatal visits and where they were evaluated for the severity of joint and skin disease, overall health, and functional ability. The doctors also recorded the drugs they were taking, including nonsteroidal anti-inflammatory drugs, corticosteroids, conventional disease modifying antirheumatic drugs (DMARDs), and biologic agents.1
These results mimic patients studied in 2017 in Canada. In this group of 29 women, researchers found that the women’s arthritis and skin disease tended to improve significantly during pregnancy.2
Postpartum symptoms and PsA
However, the protective effect of pregnancy seems to end soon after delivery for many women with PsA. The Norwegian study found that the women’s symptoms returned after delivery, peaking in severity at six months postpartum. Bodily pain, in particular, worsened between six weeks and six months postpartum. By one year after their baby’s birth, each woman’s symptoms had returned to whatever was normal for them.1
Another 2018 study, this one conducted in Israel, found similar results in a group of 25 pregnant women with PsA.3 Meanwhile, the Canadian study found that approximately 40% of mothers with PsA experienced worsening joint and skin symptoms in the year following delivery, while the rest had stable or improved symptoms in the postpartum period.2
PsA drugs and pregnancy
None of these studies attempted to answer the question of whether medicines used to treat PsA symptoms are safe to take during pregnancy. The researchers did document how many women took drugs, what types they took before and during pregnancy, and what impact those drugs seemed to have on the mother’s PsA symptoms.
Of the women in the Norwegian study, a slight majority (58%) generally took DMARDs and/or biologics for their psoriatic arthritis before becoming pregnant, but few took these medications during late pregnancy. Six months after delivery, 40 percent had returned to taking a biologic.1
Fifty percent of the women were taking non-biologic DMARDs, usually sulfasalazine, before conception, 15% were taking such drugs in the third trimester, and 27% had returned to it at six months postpartum. Prednisone was taken by 13% in the first trimester, 15% in the third trimester and 22% at six months after delivery.
Similarly, the Israeli mothers who continued taking biologics during pregnancy also experienced fewer PsA flares and symptoms. Those women who stopped taking biologics before pregnancy had more flares during their pregnancy and postpartum period.3
Ursin K, Lydersen S, Skomsvoll JF, Wallenius M. Disease activity of psoriatic arthritis during and after pregnancy: A prospective multicenter study. Arthritis Care Res. 2018 Sep 7. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30192071. doi: 10.1002/acr.23747.
Polachek A, Li S, Polachek IS, Chandran V, Gladman D. Psoriatic arthritis disease activity during pregnancy and the first-year postpartum. Semin Arthritis Rheum. 2017 Jun;46(6):740-745. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28196621 doi: 10.1016/j.semarthrit.2017.01.002.
Berman M, et al. The Effect of Pregnancy on Disease Activity in Patients with Psoriatic Arthritis. J Rheumatol. 2018 Sep 15. pii: jrheum.171218. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30219770. doi: 10.3899/jrheum.171218.