If you live with psoriatic arthritis (PsA) and are planning on—or even just considering—becoming pregnant, you might be a little nervous. Maybe you’re worried that your swollen, achy joints will feel even worse, or are concerned about whether you can keep taking your PsA medications.
While pregnancy with PsA can feel challenging, there’s some reassuring news: This type of arthritis probably won’t have as much of an impact as you might think, and there’s an excellent chance—as much as 95%, as some research shows—you’ll have a healthy pregnancy overall.1 However, controlling your symptoms can help ensure that everything turns out well and you feel as good as you can throughout this period. Here, experts outline five important things to know.
1. You should talk to your doctor well before you start trying.
Chelsey Smith, MD, a rheumatologist and assistant professor of medicine at the University of California San Diego, tells SELF that you should talk to your PsA health care provider about your plans several months before trying to conceive.2 This is for a few reasons: First, certain medications are unsafe to take while pregnant (more on which in a second). If that applies to you, you’ll want to tweak your treatment plan a bit, Nicole Smith, MD, MPH, medical director of maternal-fetal medicine at Brigham and Women’s Hospital, tells SELF. And while most people have complication-free pregnancies, you’re at a slightly higher risk for preterm birth or Cesarean section deliveries—particularly if you’re in a flare-up, Dr. Chelsey Smith says.3 Basically, if you can get your PsA symptoms under control, things will likely be a lot smoother (for you and baby), she says.
Your doctor can come up with a new treatment plan, help you map out what to expect along the way, and, importantly, communicate that info to your ob-gyn, Dr. Nicole Smith says. It’s “essential” for them to be in tight contact, Dr. Chelsey Smith says, so by linking your various health care providers up early in the process, they can give you the best care possible.
2. Yes, you may have to switch medications.
If pregnancy is a possibility this year or even next, your rheumatologist will need to take a look at all of the meds you’re on. That’s because some PsA treatments can increase the risk of certain birth defects or complications. One class of drugs that can be an issue are disease-modifying antirheumatic drugs (DMARDs), like methotrexate. which are used to slow the condition’s progression and help you avoid permanent damage to your joints and tissues.4 Some types of DMARDs, like sulfasalazine and hydroxychloroquine, might be safe to take, but your care team will have to make the final call.5
If you do need to stop or change things up, aim to do it sooner rather than later, Dr. Chelsey Smith says: “We usually recommend switching treatments at least three to six months before attempting to conceive because it’s important to ensure that the disease is well-controlled on the new treatment [prior to] pregnancy.” That said, if you unexpectedly find out you’re pregnant, don’t abruptly stop taking any prescriptions before talking to your doc, as this can trigger a flare-up.
3. Your symptoms might get better, worse, or stay the same.
If you’re concerned your pain will intensify over the next nine months, there’s some good news: Though Dr. Nicole Smith says she treats the occasional pregnant person whose symptoms worsen, most folks don’t see a difference, and a lot actually have fewer flare-ups in general.6 Reassuringly, research shows that most people fall into the latter category.7