I've been putting off writing this post for days. I have to admit that I am feeling a little bit reluctant about being my usual honest self here, because I really don't want to scare or discourage anyone out there with RA who might be considering getting pregnant.
But, ultimately, I decided that one of the things that scared me the most when I was considering getting pregnant was that there was just so little real information out there about pregnancy and RA. Sure you can find lots of articles with vague medical information - "many women with RA experience remission when pregnant" - but what does that even mean?!? How many? How much remission? What if I am not one of the "many"? Then what?!?! When I was planning to get pregnant I desperately wanted to find just a few personal stories about what being pregnant with RA is really like, so that I could have some idea - any idea - about what I realistically might be facing.
So, with the disclaimer that everyone's RA is different and there seem to be no hard and fast rules about RA and pregnancy (plus the always obvious talk to your own health care providers to figure out what is best for you), let me share with you what I am currently up against:
It's week 34 of my pregnancy - six weeks to go - and I have really been struggling.
The vast majority of the past few weeks I have been in a great deal of pain, extremely achy, highly fatigued, and seriously uncomfortable. Most days I find myself on the couch by mid-afternoon, with an ice pack on each hip, hoping for just a little numbness and relief. My hands are so stiff and sore when I wake up in the morning I feel like it's a wonder if I can make myself a cup of tea. I'm exhausted and having trouble sleeping. I take my tylenol and pretend that it's vicodin, hoping to trick my brain into feeling better.
Despite the mounting evidence over the past few weeks, I've been in a little bit of denial about the return of my RA symptoms. Some part of me kept stubbornly insisting that these issues could just as easily be caused by third trimester pregnancy as by RA. There's a huge belly and a lot of extra weight on those hips - no wonder they hurt! I have another pregnant friend who is dealing with swelling in her hands - maybe that's all it is! And all pregnant women are exhausted and have trouble sleeping! Just hang in there!
But then last week my prenatal massage therapist commented on the heat radiating out of my hips. Then my pilates instructor commented on how hot my hands were and pointed out that my shoulder was behaving just like it does during a flare. Then, despite keeping my exercise routine extremely low impact, I suddenly started experiencing some unexpected - yet highly familiar - pain in my knee that sent me searching for my knee brace. Within a day or two I started noticing increased pain in both of my knees whenever I stood or walked for longer than a few minutes.
With the number of affected joints adding up, it seemed more and more difficult to say that this pain was pregnancy-related (rather than-arthritis related.) So I brought it up with my OB on Monday - and she agreed. While pregnant women often experience hip pain, she told me, the hand pain and the knee pain clearly suggested arthritis. And despite everything I have been doing to try to manage the pain (physical therapy, pilates, water aerobics, prenatal massage, heat, cold, rest, relaxation, de-stressing...) the pain was only getting worse. My OB's concern only increased when I told her about the difficulty I had practicing birth positions. She thought it was time to start taking some prednisone.
As anyone who has read this blog in the past knows, I sincerely dislike prednisone. Ok, let's not lie: I pretty much hate the stuff. I hate that it works so well but comes with such nasty side effects (at least that's how it seems to work for me). I hate the way it makes me look and feel. I hate how hard it is to wean off of once you have been on it for an extended period of time. (And I hate how I feel like just a tiny bit of a failure for having to resort to prednisone when I really don't want to...even though I know that is absurd.)
Unfortunately, even putting aside my personal feelings about prednisone, the decision to start taking it while pregnant is just not quite as simple as I wish it was. It does come with a price. First, prednisone (or any steroid) can mess with your adrenal gland, and if your adrenal gland isn't working properly it can inhibit labor. So being on prednisone now will require me to have an IV dose of some other drug (can't remember the name...placenta brain!) during labor to make sure my adrenal gland is functioning well enough to get me through labor. This is obviously not the end of the world. It's not like I'm a stranger to IVs, and it sounds like I'll only need one dose - so I won't necessarily be tethered to an IV the whole time.
The other issue is the side effects. We know that in the past prednisone has seemed to mess with my blood pressure. And, since my favorite jug-o-pee test did come back a little bit high, I am still at risk for developing preeclampsia. This would obviously not be safe for me or the baby. So we'll have to keep an extra close eye on my blood pressure while I am taking the prednisone to make sure everything progresses safely.
But, despite all of this, I am also reasonable enough to recognize that prednisone is pretty much my only option right now. It will help control my RA symptoms while also being safe for the baby. It will make the remainder of this pregnancy more bearable. It will reduce the joint pain which will help me get through labor. And feeling better right now and having a less painful and productive labor is better for me and the baby.
So, my love-hate relationship with prednisone continues. And, honestly? After just one dose yesterday I swear I am already feeling better today.