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Rheumatic Diseases in Pregnancy

What are Rheumatic Diseases in Pregnancy?

Rheumatic diseases in pregnancy refer to a group of autoimmune and inflammatory conditions in Singapore that affect the musculoskeletal system, such as rheumatoid arthritis, systemic lupus erythematosus (SLE), ankylosing spondylitis, psoriatic arthritis, and others. These diseases are characterised by inflammation, pain, and swelling in the joints, but they can also affect other organs and tissues in the body.

 Rheumatic disease pregnancy
Pregnant women are more prone to rheumatoid disease that can result in hand and finger pain

What causes Rheumatic Diseases in Pregnancy?

Rheumatic diseases are autoimmune conditions that can affect the joints, muscles, and other tissues in the body. These diseases can develop during pregnancy but are not directly caused by pregnancy. Instead, several factors may contribute to developing or exacerbating rheumatic diseases during pregnancy.

What are the symptoms of Rheumatic Diseases in Pregnancy?

Rheumatic diseases can encompass a variety of conditions, each with its own set of symptoms. Some common symptoms associated with rheumatic diseases in pregnancy include:

  • Increased joint pain and swelling: many rheumatic diseases involve joint inflammation, which may become more pronounced during pregnancy due to hormonal changes and increased joint stress.
  • Fatigue: chronic fatigue is a common symptom in people with rheumatic diseases, and pregnancy can exacerbate this feeling of tiredness.
  • Flare-ups: some individuals may experience disease flare-ups during pregnancy, leading to increased symptoms and discomfort.
  • Difficulty with mobility: joint pain and stiffness can make it challenging for pregnant women to move comfortably, especially as the pregnancy progresses.
  • Psychological and emotional challenges: living with a chronic condition during pregnancy can be emotionally taxing, leading to stress and anxiety.

Is Rheumatic Disease during Pregnancy painful?

Whether or not rheumatic disease during pregnancy is painful depends on several factors, including the type and severity of the rheumatic disease, the individual's overall health, and how well the disease is managed.

Some rheumatic diseases, such as rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis, often involve joint pain and inflammation, which can be painful. Pregnancy-related hormonal changes and the increased stress on the joints and muscles during pregnancy can potentially exacerbate this pain.

However, the degree of pain can vary. Some individuals with rheumatic diseases may experience mild discomfort during pregnancy, while others may have more severe pain and limitations in their daily activities.

Who is at risk of developing Rheumatic Diseases in Pregnancy?

Here are some key factors that can increase the risk of rheumatic diseases during pregnancy:

  • Genetic predisposition: many rheumatic diseases have a genetic component. An individual with a family history of a particular rheumatic disease may have a genetic predisposition to develop that condition.
  • Hormonal changes: pregnancy involves significant hormonal changes, including increased levels of oestrogen and progesterone. These hormonal shifts can affect the immune system and may influence the course of certain rheumatic diseases.
  • Immune system alterations: pregnancy induces changes in the immune system to support the developing foetus. In some cases, the immune system may become more or less active during pregnancy, potentially affecting the progression of rheumatic diseases.
  • Stress: pregnancy can be physically and emotionally stressful. Stress exacerbates symptoms of autoimmune conditions, and high-stress levels during pregnancy may contribute to developing or worsening rheumatic diseases.
  • Infections: infections can sometimes trigger autoimmune responses in individuals genetically predisposed to autoimmune diseases. Pregnancy can make the immune system more susceptible to infections, and this heightened susceptibility could potentially play a role in the development of certain rheumatic diseases.
  • Environmental factors: exposure to environmental factors, such as toxins or pollutants, can contribute to the development or exacerbation of autoimmune conditions, including some rheumatic diseases.

If a pregnant woman experiences symptoms suggestive of rheumatic disease, consult with a rheumatologist for a thorough evaluation and appropriate management.

What complications can arise due to Rheumatic Diseases during Pregnancy?

Rheumatic diseases can pose certain pregnancy-related complications and risks. These complications can affect both the mother and the developing foetus. Some of the complications associated with rheumatic diseases during pregnancy include:

  • Disease flares: some individuals with rheumatic diseases may experience increased disease activity during pregnancy. This can lead to symptoms such as joint pain, swelling, fatigue, and skin rashes. Disease flares can negatively impact the mother's well-being and quality of life.
  • Preterm birth: women with active rheumatic diseases, particularly those with poorly controlled disease activity, may be at an increased risk of preterm birth.
  • Low birth weight: babies born to mothers with active rheumatic diseases may be more likely to have a low birth weight, which can increase the risk of health problems for the baby.
  • Preeclampsia: preeclampsia is a pregnancy complication characterised by high blood pressure and damage to organs, typically the liver and kidneys. Some rheumatic diseases, such as SLE, can increase the risk of preeclampsia.
  • Foetal growth restriction: active rheumatic diseases may impair the baby's growth and development in the womb, leading to foetal growth restriction.
  • Neonatal lupus: in mothers with SLE, antibodies from the mother can sometimes cross the placenta and affect the developing foetus. This can lead to a condition known as neonatal lupus, which may cause skin rashes, liver problems, or heart block in the newborn.
  • Medication risks: some medications for managing rheumatic diseases may potentially risk the developing foetus. It is essential to carefully weigh the benefits and risks of medication use during pregnancy and, when necessary, adjust or change medications under the guidance of your doctor.
  • Postpartum flares: some women experience a flare of their rheumatic disease in the postpartum period, which requires ongoing monitoring and management.
Preeclampsia
Women with preeclampsia must be closely monitored during pregnancy

How is Rheumatoid Diseases in Pregnancy diagnosed?

Here are the steps typically taken to diagnose rheumatoid disease in pregnancy:

  • Medical history: a medical history of any symptoms the pregnant woman is experiencing, including joint pain, swelling, stiffness, and other relevant symptoms, will be noted. Information about previous pregnancies and any history of rheumatic diseases or autoimmune conditions is also important.
  • Physical examination: a physical exam will assess joint function, range of motion, and any signs of inflammation, such as joint swelling and warmth. Other body parts, including the skin, eyes, and mouth, may also be examined for signs of systemic involvement.
  • Blood tests: several blood tests can help diagnose rheumatoid disease during pregnancy. Common blood tests include:
    • Rheumatoid factor (RF): this antibody is often elevated in individuals with rheumatoid arthritis.
    • Anti-cyclic citrullinated peptide (anti-CCP) antibody: elevated levels of anti-CCP antibodies are a specific marker for rheumatoid arthritis.
    • C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR): these measure markers of inflammation, which can be elevated in rheumatoid disease.
    • Complete blood count (CBC): anaemia is common in rheumatoid arthritis and may be detected through a CBC.
  • Imaging studies: X-rays, ultrasound, or magnetic resonance imaging (MRI) may be used to assess joint damage or inflammation. However, these imaging studies may be limited during pregnancy to minimise radiation exposure to the developing foetus. Ultrasound is often preferred for joint evaluation during pregnancy because it does not involve ionising radiation.

What are the treatment options for Rheumatic Diseases during Pregnancy in Singapore?

The treatment approach depends on the specific rheumatic disease, its severity, and the individual's health status.

Treating rheumatic diseases during pregnancy includes:

  • Medication management: some medications used to treat rheumatic diseases may need to be modified or discontinued during pregnancy due to potential risks to the foetus.
  • Disease monitoring: disease activity and overall health throughout pregnancy will be managedby monitoring symptoms, physical examinations, and laboratory tests to ensure the rheumatic disease is well controlled.
  • Non-pharmacological approaches: physical therapy, occupational therapy, and lifestyle modifications can help improve joint function and reduce pain.
  • Pain management: safe pain relief options, including certain medications, can be used to help alleviate pain.
Physical therapy pregnant
Pregnant women with rheumatoid disease may receive supervised physical therapy to support their well-being.

Make an appointment with Asia Arthritis Rheumatology Centre where we prioritise our patient’s health by ensuring accurate diagnosis and personalised treatment.

Frequently Asked Questions

Can having a rheumatic disease affect my baby's long-term health and development?

While managing your condition is essential, with proper care and treatment, most babies born to mothers with rheumatic diseases grow and develop normally.

Can I have a normal vaginal delivery if I have a rheumatic disease during pregnancy?

The mode of delivery depends on your specific condition and health status. Your doctors can determine the safest delivery method for you and your baby.

Are there any lifestyle changes or exercises I can do to manage my rheumatic disease symptoms during pregnancy?

Yes, gentle exercises and physical therapy can help manage symptoms.

How do early diagnosis and consultation with specialists impact the management of pre-existing rheumatic diseases during pregnancy?

Initiate discussions with your medical team well before conception. This ensures a comprehensive understanding of effectively handling these conditions throughout pregnancy.

If you have never received a diagnosis of a rheumatic disease and encounter symptoms while pregnant or when considering pregnancy, seeking an assessment from a rheumatologist or a specialist in maternal-foetal medicine is essential. This proactive approach can help minimise the risk of pregnancy-related complications.

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Dr Annie Law

Senior Consultant Rheumatologist
MB BCh BAO, MRCP (UK), MMed,
FAMS (Rheumatology)

Dr Annie Law is an experienced Senior Consultant Rheumatologist and Medical Director at Asia Arthritis & Rheumatology Centre.

She leads subspecialty SLE clinics, showcasing her dedication to lupus care. Dr Annie Law has been duly recognised for patient-oriented care, earning multiple awards. Her extensive education includes FAMS (Rheumatology) and MRCP (General Medicine). Actively involved in lupus research, she established a lupus database and contributed to paramount protein therapy discoveries. Dr Law is a committed medical educator, holding faculty positions and receiving accolades for her teaching. Her impactful contributions extend to the professional organisation for rheumatology in Singapore exemplifying deep commitment to advancing rheumatology knowledge.

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