eMedicine Specialties > Rheumatology > Rheumatoid Arthritis

Rheumatoid Arthritis and Pregnancy: Differential Diagnoses & Workup

Author: Katherine Temprano, MD, Assistant Professor of Internal Medicine, Associate Program Director, Rheumatology Fellowship Program, Division of Rheumatology, University of Kentucky Medical Center
Coauthor(s): Shannon Colleen Florea, MD, Fellow, Department of Internal Medicine, Division of Rheumatology, University of Kentucky Medical Center; Elizabeth Scarbrough, MSN, Rheumatology Nurse Practitioner, University of Kentucky Chandler Medical Center
Contributor Information and Disclosures

Updated: Jun 22, 2009

Workup

Laboratory Studies

The laboratory blood tests used to assess rheumatoid arthritis (RA) disease activity in pregnant women are the same tests performed in any pregnancy.

  • A hematocrit study is used to screen for anemia.
  • Blood group testing is used to identify Rh-negative mothers.
  • Rapid plasma reagent, hepatitis B, and HIV tests are used to evaluate for diseases that can potentially affect the fetus.
  • The presence of rheumatoid factor does not help predict or correlate with the outcome of arthritis during pregnancy, so this test is not required.1
  • The erythrocyte sedimentation rate cannot be used to assess RA disease activity during pregnancy, as pregnancy alters the normal values.
  • Because normocytic-normochromic anemia of chronic disease can develop in persons with RA, closer monitoring of hemoglobin values may be required. The volume expansion that occurs during pregnancy can result in lower hematocrit values.
  • Patients who are taking disease-modifying antirheumatic drugs (DMARDs) may need to undergo blood work to monitor for adverse effects of the drugs.

Imaging Studies

  • Radiography of the neck: Flexion and extension views of the neck are required in patients with persistent neck pain and neurological symptoms in whom ligamental instability is suggested.
  • Ultrasonography: No specific guidelines address obstetric monitoring in patients with RA. Because little available data suggest a significant risk for preterm birth, pre-eclampsia, or fetal growth restriction in pregnant patients with RA, no special obstetric monitoring is indicated beyond what is performed for usual obstetric care.15

More on Rheumatoid Arthritis and Pregnancy

Overview: Rheumatoid Arthritis and Pregnancy
Differential Diagnoses & Workup: Rheumatoid Arthritis and Pregnancy
Treatment & Medication: Rheumatoid Arthritis and Pregnancy
Follow-up: Rheumatoid Arthritis and Pregnancy
References
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References

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Further Reading

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Keywords

rheumatoid arthritis and pregnancy, RA, arthritis, DMARDs and pregnancy, disease-modifying anti-rheumatic drugs, disease-modifying antirheumatic drugs, spontaneous abortions, preeclampsia, preterm delivery, pregnancy complications, pregnancy management, adverse fetal outcome, decreased sexual drive, ovulation dysfunction, impaired hypothalamic-pituitary-adrenal axis, impaired HPA axis

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Contributor Information and Disclosures

Author

Katherine Temprano, MD, Assistant Professor of Internal Medicine, Associate Program Director, Rheumatology Fellowship Program, Division of Rheumatology, University of Kentucky Medical Center
Katherine Temprano, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine and American College of Rheumatology
Disclosure: Nothing to disclose.

Coauthor(s)

Shannon Colleen Florea, MD, Fellow, Department of Internal Medicine, Division of Rheumatology, University of Kentucky Medical Center
Shannon Colleen Florea, MD is a member of the following medical societies: American College of Rheumatology
Disclosure: Nothing to disclose.

Elizabeth Scarbrough, MSN, Rheumatology Nurse Practitioner, University of Kentucky Chandler Medical Center
Elizabeth Scarbrough, MSN is a member of the following medical societies: American College of Rheumatology, Council for the Advancement of Nursing Science, and Sigma Theta Tau International
Disclosure: Nothing to disclose.

Medical Editor

Bryan L Martin, DO, Chief, Allergy Immunology Department, Walter Reed Army Medical Center; Associate Professor of Medicine and Pediatrics, Uniformed Services University of the Health Sciences; United States Army Consultant in Allergy Immunology and Immunizations
Bryan L Martin, DO is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, American College of Osteopathic Internists, American College of Physicians, American Medical Association, and American Osteopathic Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Ajay K Singh, MB, MRCP, MBA, Associate Professor of Medicine, Harvard Medical School; Clinical Chief, Renal Division, Director of Dialysis, Brigham and Women's Hospital; Consulting Staff, Faulkner Hospital
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

David Chelmow, MD, Professor of Obstetrics and Gynecology, Tufts University School of Medicine; Program Director, Tufts University Affiliated Hospitals Obstetrics/Gynecology Residency Program; Chair, Tufts University Health Sciences Campus Institutional Review Board; Vice Chair for Research and Education, Department of Obstetrics/Gynecology, Tufts Medical Center
David Chelmow, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Phi Beta Kappa, Sigma Xi, Society for Gynecologic Investigation, and Society for Medical Decision Making
Disclosure: Nothing to disclose.

 
 
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