Pregnancy is not a disease but the changes that occur in the body can sometimes worsen existing conditions or even trigger new illnesses. Sometimes these conditions are short-lived and will resolve after childbirth. At other times conditions that start in pregnancy may persist for life. Joint inflammation, more commonly known as arthritis, is one such condition that may be a problem for some pregnant women.
What is pregnancy arthritis?
Pregnancy arthritis is not a specific pregnancy-related condition despite its name. It refers to arthritis that starts during pregnancy or worsens during pregnancy. Pregnancy arthritis is not a medical term but rather a common way of describing joint inflammation that occurs or worsens or starts in pregnant women. This occurs for a number of reasons including the weight gain as a result of pregnancy, the effect of the pregnancy hormones and even injuries sustained as a result of impaired movement in late pregnancy.
Causes of Pregnancy Arthritis
It is important to note that pregnancy does not cause arthritis. Instead certain types of arthritis may arise or worsen during pregnancy. The two most common types of arthritis are osteoarthritis and rheumatoid arthritis.
Pregnancy and Osteoarthritis
Osteoarthitis is the most common type of arthritis but is more frequently seen in older people. It starts early in life and develops gradually over decades. Osteoarthritis is not an inflammatory joint condition but occurs when the cartilage of the joint degenerates. This is usually due to wear and tear. It is unlikely to start in pregnancy but may become apparent in the pregnant state.
The weight gain that occurs as a normal part of pregnancy increases the strain on the joints. In osteoarthritis it is the large joints that are usually affected. Therefore pregnant women may experience pain of the joints, such as the hip, knee and ankle, due to ongoing strain. However, even when the joints experience acute strain this may not necessarily be due to osteoarthritis.
Pregnancy and Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune condition where the immune system attacks the joint lining thereby causing joint inflammation. It tends to affect the small joints like the that of the fingers and women are more often affected. Many women with rheumatoid arthritis find an improvement of their condition during pregnancy. It appears that the pregnancy alters the immune system thereby reducing the inflammation and easing symptoms.
However, remission of rheumatoid arthritis is not permanent and the symptoms reappear after childbirth. Sometimes it can be worse than it was before pregnancy. Not all women with rheumatoid arthritis experience this improvement. Some may find that the inflammation persists or even worsen during pregnancy. These flareups may be directly related to the pregnant state or due to discontinuing anti-inflammatory drugs that are not safe to use in pregnancy.
Pregnancy and Post-Traumatic Arthritis
Post-traumatic arthritis is joint inflammation due to an injury. It is not a condition that is specific to pregnancy. However, pregnant women are prone to accidents and falls for several reasons and joint injury may occur as a result. This can occur with decreased mobility due to pregnancy weight gain and a shift in the center of the gravity, dizziness that may arise with anemia and low blood pressure in pregnancy, and so on. Post-traumatic arthritis can lead to osteoarthritis.
Signs and Symptoms
Arthritis presents with joint pain, swelling, redness over the affected joint and stiffness. However, not all of these symptoms may be present depending on the type of arthritis and severeity.
Pain and Swelling
Joint pain is the most common symptom of these types of arthritis. It is important to note that arthritis refers to joint inflammation while the term arthralgia refers to joint pain. The pain is typically worse with strain such as when walking or standing for long periods. Other symptoms of inflammation such as redness and swelling may also be present especially with rheumatoid arthritis and post-traumatic arthritis. Redness isnot usually evident in osteoarthritis.
Stiffness and Location
The joint function is affected to varying degrees in all types of arthritis. The is characterized by joint stiffness and the range of motion may also be diminished. Sometimes moving the affected joint that is stiff may lead to loud grating or clicking sounds. Post-traumatic arthritis can affect any joint that is injured but theaffected joints is more specific with rheumatoid arthritis and osteoarthritis.
With rheumatoid arthritis, the stiffness is typically present in the hand joints and affects both sides. Morning stiffness is characteristic of rheumatoid arthritis but the stiffness usually eases with movement. In osteoarthritis the large joints like the hip and knee are more often affected. Stiffness is more prominent with movement particularly when a person physically exerts themselves.
Treatment of Pregnancy Arthritis
Understandably medication is prescribed cautiously in pregnancy. However, many of the drugs that are used may not threaten fetal development. It is important that pregnant women first consult with a medical professional before using any drug for arthritis. Medication used for arthritis in the non-pregnant state may not be suitable for pregnancy and immediate discontinuation may be warranted.
It is important to note that topical medication like ointments and balms could also pose a risk for pregnant women. Do not be misled in believing that these products are safe because they are sold over-the-counter. Rather opt for simple conservative measures like cold or heat where applicable and resting, using a brace for the affected joint and resting as far as possible.
Treatment options for osteoarthritis may not be warranted in women of a reproductive age. Usually this condition becomes severe later in life. Therefore the short period till the end of pregnancy without treatment will not pose a problem. In fact treatment for osteoarthritis is rarely started before the senior years so discontinuation of treatment is not usually a consideration for pregnant women.
The situation is significantly different for rheumatoid arthritis, especially in women who were already on treatment prior to falling pregnant. Corticosteroids is a commonly used drug in rheumatoid arthritis and may be safely used in the second and third trimester. However, it is important to seek the advice of a medical professional before starting or continuing with drugs for rheumatoid arthritis, even if it is just for controlling the symptoms.