Psoriatic Arthritis and Pregnancy

Half of all people with psoriatic arthritis (PsA) are women, and most of them are diagnosed during their childbearing years. PsA does not interfere with a woman’s ability to become pregnant, nor does it impact fertility.^1-3

However, some medications used to treat PsA are not safe in pregnancy. It is a good idea to understand how PsA affects pregnancy and what you might expect.^1-3

PsA symptoms during pregnancy

Some pregnant women will experience a reduction in their PsA symptoms, or their symptoms may stay stable. Others’ PsA symptoms will get worse. Every person is different.^1,2

For those who experience an increase in the severity of their PsA symptoms, they might have:¹

• Joint pain
• Swelling, which may worsen due to weight gain during pregnancy
• Inflammation and pain in the spine (spondylitis)
• Inflammation and pain in the lower spine and pelvis (sacroiliitis), which may worsen with physical changes and a growing belly during pregnancy
• Fatigue

Treatment of PsA during pregnancy

The treatment of PsA before getting pregnant, during pregnancy, and while breastfeeding must be closely monitored by a rheumatologist and obstetrician (OB-GYN). Some medicines used to treat PsA are safe for both mom and baby to take. But there are other drugs that may not be safe.^1-3

Talk to your doctor about your medicines before becoming pregnant. Some systemic and biologic drugs should be avoided during pregnancy and while breastfeeding. The National Psoriasis Foundation has treatment guidelines for women who are pregnant or breastfeeding.²

One risk of taking biologic medications during pregnancy is having a premature baby. A 2022 study found that those who were taking biologic medicines to treat their PsA had higher rates of preterm birth and cesarean (C-section) deliveries. There was also a higher rate of preterm births in first pregnancies.²

Other PsA medicines, such as antirheumatic drugs, are also unsafe to take while planning to become pregnant, during pregnancy, and while breastfeeding. These include:¹

• Rheumatrex®, Trexall® (methotrexate)
• Avage®, Rabior®, Tazorac® (tazarotene)
• Soriatane® (acitretin)
• Absorica®, Claravis®, Myorisan® (isotretinoin)

Above all, treatment should be tailored to meet the needs of the mother and the developing baby. Talk with your rheumatologist about which medicines are safe to take.

PsA after pregnancy (postpartum)

Most people with PsA go on to have successful births and healthy babies. Just as the body goes through many changes while growing a baby, the same happens after pregnancy.^1-4

There is the possibility of having a PsA flare-up after giving birth. This is fairly common, and it may take a while after birth for symptoms to intensify. In a 2019 study, researchers found that flare-ups most commonly occurred about 6 months after giving birth.^1-4

Having a solid support system can make a big difference in managing potential flare-ups and postpartum symptoms in general. Here are some tips to manage and ease symptoms:¹

• Get plenty of rest. Try to time your naps when your baby naps so your body can recover. It is important to get enough sleep.
• Do light physical activity. If possible, try going for a walk at least once a day to start. You can build up your activity from there.
• Eat well. Fuel your body with plenty of fiber-rich vegetables, fruits, whole grains, and lean protein.

Talk with your doctors

Living with PsA should not interfere with your wish to start a family. If you have PsA and are thinking of becoming pregnant, schedule appointments with your rheumatologist and OB-GYN. They will be able to discuss which medicines are safe to continue taking and which are not. They also will help you prepare based on your needs.