Last update: Feb. 11, 2020
Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
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Autoimmune disease where the immune system mistakenly attacks cells and tissues, potentially damaging the joints, but also the heart, skin, eyes, lungs and arteries and veins.
It is more frequent in women than in men. The disease usually occurs in the form of outbreaks with intermediate periods without symptoms. Smoking is a major trigger.
About half of women with active rheumatoid arthritis improve with pregnancy and most relapse in the first months postpartum making it difficult for them to care for their baby and breastfeed (Bermas 2017 de Jong 2017, Krause 2016, Østensen 2007).
Some studies found a higher risk of recurrence with breastfeeding, especially in the first pregnancy (Vieira 2019). High levels of prolactin have been found in patients with rheumatoid arthritis (Wu 2019).
A lower risk of subsequent arthritis has been found in women who have breastfed (Orellana 2017, Chen 2015).
Having been breastfed decreases the risk of suffering from rheumatoid arthritis (Colebatch 2011, Young 2007, Jacobsson 2003,).
Expert authors and rheumatology associations consulted do not contraindicate breastfeeding but advocate carefully choosing anti-inflammatory and immunosuppressive drugs (Paizis 2019, Anderson 2019, Bermas 2017, de Jong 2017, Krause 2016, Ngian 2016, Götestam-EULAR 2016, Flint 2106 , Kavanaugh 2015, Sammaritano 2014, Makol 2011, Weber 2008, Østensen 2009, 2008 and 2007, Needs 1985).
Ibuprofen, paracetamol, hydroxychloroquine, corticosteroids, cyclosporine, sulfasalazine and methotrexate at doses up to 25 mg per week are safe (Thorne 2014).
Among monoclonal antibodies against tumor necrosis factor (antiTNF) adalimumab, certolizumab and infliximab are safe during breastfeeding because they are not excreted in breastmilk.
There is no data to date to suggest that Janus kinase inhibitors such as baricitinib and tofacitinib are safe (Anderson 2018 and 2016, de Jong 2017).
Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.
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e-lactancia is a resource recommended by Academy of Breastfeeding Medicine from United States of America
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