September 28, 2022
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Photography by Magida El-Kassis/Stocksy United
I want others to know that it’s possible to start a family despite your diagnosis.
Many unseen struggles come with a psoriatic arthritis (PsA) diagnosis. I was diagnosed with juvenile arthritis at age 2. After several years and a couple of different treatments, I achieved remission for most of my adolescence.
But when my symptoms came back at 19, I struggled to find a rheumatologist willing to treat me.
I was told my bloodwork looked fine and that my joint pain was probably from overuse in the gym. Without treatment, my disease activity progressed, and my symptoms worsened until it became undeniable that something more was going on.
When I was finally diagnosed with psoriatic arthritis at 26, I felt a sense of relief. I had the answers I’d been searching for. But my moment of relief was short-lived. At my first appointment with my new rheumatologist, he asked me about my plans for starting a family. I’d never thought that my arthritis could complicate that part of my life.
My doctor explained that because my PsA had gone untreated for so many years, it would take time and effort to get it under control, and the high levels of inflammation and disease activity could make it difficult for me to conceive. At the time, my husband and I weren’t planning to start a family for another couple of years, but the news made it clear that the process would be more complicated than we thought.
I immediately started a biologic, hoping that it would be enough. Unfortunately, it wasn’t, and my doctor suggested adding methotrexate to my treatment plan. Methotrexate is extremely unsafe for pregnancy, often requiring patients to be on birth control while taking it and allowing at least 3 months after stopping treatment before trying to conceive.
I felt defeated at first, but after some time to process, I became determined. I decided to start the methotrexate with my biologic, and my rheumatologist and I made a plan. I would do the combination therapy while also making lifestyle changes. I quit drinking alcohol, committed to mindfulness and exercise for stress management, and made a career switch from preschool teaching and nannying to freelance social media work and writing to give my body some much-needed rest.
After about a year of this new protocol, my PsA was well under control. I still had minor flares and daily pains from joint damage, but my bloodwork was finally back in check, and I felt ready to start trying for a baby. I was thrilled when my doctor agreed, and we began the process of switching my meds to pregnancy-safe alternatives. I came off of methotrexate and started Cimzia, the safest biologic for pregnancy.
I did my best to stay relaxed while my husband and I tried for a baby. Stress is a big trigger for my flares, and I wanted to avoid worsening my symptoms. After a few months, we got our wish: I had a positive pregnancy test! I was so grateful and proud of all I’d overcome to get to that point.
I’d spent the last couple of years getting my body “ready” for pregnancy — or so I thought! Nothing could’ve prepared me for the first trimester’s highs, lows, and wild symptoms.
I didn’t experience morning sickness but all-day sickness. My nausea started at 5 a.m. and came in big waves throughout the day. I had aversions to foods I usually loved. It was topped off by the most intense fatigue of my life, lower back and pelvic pain, and a lot of anxiety from all of the hormones. I felt overwhelmed but knew that I had to find ways to cope before the stress took a toll on my body.
I started by figuring out how to manage the nausea. I realized it was at its worst whenever my stomach was empty. I began keeping snacks readily available at all times. My nightstand, car, and purse were stocked with salty crackers, applesauce packets, granola bars, and ginger candies. Despite how unappealing it sounded, I pushed myself to increase my protein intake. Gradually my nausea got better, and by week 12 of my pregnancy, the worst of it had subsided.
Soon my appetite returned, but then came the cravings. Suddenly all I wanted was bagels and fries. I decided not to deny myself these things. I enjoyed them in moderation and paired them with more satiating, healthy choices like lean protein and veggies to keep my blood sugar balanced.
Once I was spending less time hovering over the toilet, I wanted to start exercising again. But there was another roadblock in my way: debilitating fatigue. As someone with PsA, dealing with fatigue is nothing new to me. But the chronic illness fatigue paired with pregnancy fatigue was next-level. I felt like no matter how much sleep I got, I still needed a nap by mid-afternoon. Instead of fighting that urge, I gave in. I know not everyone has the luxury of flexible work hours, but even taking a 30-minute break to relax can really make a difference.
Every person living with arthritis has been reminded by their doctors how important it is to stay active. I knew I needed to find a way to keep myself moving throughout my pregnancy, so I started with the basics — walking and stretching. I made small goals and gradually built on them: just 30 minutes of exercise a few times a week. Not only did it feel great to get my joints moving again, but it also helped ease some of the anxiety I was experiencing.
The early weeks of pregnancy can be isolating and scary while you wait to find out if everything is okay in the first appointments. The influx of hormones can make anxieties even more intense. I found myself constantly worried and fearing the worst possible outcomes.
Living with arthritis and having a body that’s so volatile made it hard for me to trust the process and feel connected to my pregnancy at first. Almost like my brain was protecting itself. I felt terrible for my sudden loss of excitement, and I desperately wanted to feel more connected. I didn’t want to miss out on the joy and beauty of it all.
I’d lost my morning meditation routine while dealing with my nausea and exhaustion. I knew I needed to bring it back to feel better. I started prioritizing just a few minutes of guided meditations, positive affirmations, or breathing exercises right when I woke up. Practicing gratitude really helped me through moments of fear and uncertainty.
Another way I’ve managed the anxiety of early pregnancy has been by turning to my online community. I’m so very lucky to be going through this stage of life at the same time as some of my Instagram and Bezzy PsA pals. Having a friend who understands the struggles of pregnancy and balancing pregnancy and PsA has made a world of difference. Being able to vent about the ups, downs, and challenges of this new normal makes me feel less alone.
Navigating pregnancy with psoriatic arthritis certainly hasn’t been easy, but I feel it’s important to share my journey. Just a couple of years ago, I wondered if pregnancy would even be possible for me. I want other people like me to know that even though it might be difficult and take longer than you hoped, it is possible to start a family despite your diagnosis.
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