Your questions on family planning and arthritis

Can pregnancy cause rheumatoid arthritis?

Q) I read with interest the question and answer about why rheumatoid arthritis improves in pregnancy. I've been wondering about a related problem since I developed a rheumatoid condition soon after I gave birth. I've since discovered many women who've had a similar experience after childbirth and I was wondering whether there has been any research done in this area, as it seems to me that in the same way the immune system is switched off during pregnancy, it's possible that it's over-activated when it all comes back. My condition has finally gone into remission five years after my son’s birth with the aid of methotrexate.

Christine, Cambridge - 2010

A) Yes, relapse after pregnancy, and new onset rheumatoid arthritis after giving birth, are both well recognised. That's why we take appropriate measures to restart any necessary treatments as soon as possible after the delivery. Clearly, there are big changes occurring in the body and the immune system during pregnancy, and it's possible that these huge swings leave the woman vulnerable to autoimmune conditions such as rheumatoid arthritis.

This answer was provided by Dr Philip Helliwell in 2010, and was correct at the time of publication.

Why was there no sign of rheumatoid arthritis when I fell pregnant?

Q) I've had rheumatoid arthritis for nearly 29 years. When I fell pregnant, there was no sign of rheumatoid in my body. Many people will tell you the same, so how come this isn't researched? Could something like the contraceptive pill take rheumatoid away?

Lynn, Carlisle, Cumbria - 2010

A) You're right. This phenomenon has fascinated rheumatologists for a long time. Research has been done, but I'm afraid taking the contraceptive pill isn't the answer. In fact, there are many dramatic changes in a woman's body during pregnancy, most of which, unlike the bump, aren't visible. Hormonal and immunological changes occur so that the pregnancy can proceed to a successful outcome. Don't forget that the baby is a little alien as far as the mother's body is concerned, with half the genetic material coming from the father. In order for the mother not to 'reject' the growing baby, it must become 'tolerant'. I use inverted commas around both these words, as they are terms used by immunologists. The bottom line is that for the baby to grow successfully, the mother's body must undergo some immune alteration and this is probably why rheumatoid arthritis improves in pregnancy. Modern drugs to treat rheumatoid arthritis, such as methotrexate and anti-TNF drugs, also alter the immune system, so in a way we're already following the body's lead on this. Of course, after delivery, all these changes disappear, so it's not uncommon for the rheumatoid arthritis to relapse a few weeks after delivery. This is always a letdown for the mother and is something we try and prevent by restarting treatment after the baby is delivered. Which drugs are safe in pregnancy and while breastfeeding is a whole topic on its own, which I would be happy to tackle in future answers.

This answer was provided by Dr Philip Helliwell in 2010, and was correct at the time of publication.