Rheumatoid arthritis medications: Dangerous during pregnancy?

Rheumatoid arthritis is a chronic inflammatory disorder. It can affect more than just your joints. In some cases, the condition can harm a wide variety of organs, including the skin, eyes, lungs, heart and blood vessels. This occurs when one’s immune system mistakenly attacks their own body’s tissues. Some medications used to treat rheumatoid arthritis may be dangerous for an unborn baby.

Most rheumatoid arthritis medications work by suppressing your immune system. Other commonly prescribed drugs control inflammation. Each type of drugs has its own risk. Some drugs may cause birth defects while others can induce a miscarriage. Some are able to raise your risk of high blood pressure or diabetes. The timing is also important. Some drugs only need to be avoided in the third trimester whereas some should be eliminated completely during pregnancy.

Common drugs for rheumatoid arthritis that should be avoided during pregnancy and breastfeeding are:

Methotrexate (Trexall)

Methotrexate is very common in treating rheumatoid arthritis. It can cause miscarriage early in pregnancy. If taken during pregnancy, it is likely to cause birth defects of the brain and bones.

Leflunomide (Arava).

Leflunomide should be avoided even before conception because doctors believe it can remain in the body for a long time. If you need to speed up the elimination process, your doctor may give you another drug called cholestyramine.

Biologic response modifiers.

There has not been much evidence on how this class of drug may harm an unborn baby. However, most doctors recommend avoidance if you plan to conceive, just to be safe. Common drugs belong to this class are anakinra (Kineret), rituximab (Rituxin), abatacept (Orencia) and tocilizumab (Actemra).

If you are taking these kinds of drugs, you should always use contraception. If you plan to get pregnant, talk to your doctor for other less risky medications. It’s best to avoid certain rheumatoid arthritis medications for several months before conception. That goes for both men and women.

Low-dose prednisone, for example, is generally considered safe during pregnancy. Hydroxychloroquine (Plaquenil) and sulfasalazine are also believed to be safe. While evidence is limited for biologic medicines like etanercept (Enbrel), etanercept-szzs (Erelzi), infliximab (Remicade), and infliximab-dyyb (Inflectra), a biosimilar, many rheumatologists are confident in their relative safety during pregnancy.

The best way to avoid any risk is to quit medication completely. However, that has its own price. If you stop using medication, you may be at risk of progression of joint damage. Some women are advised to take this approach but they have to be monitored closely for any disease activity.