Women with rheumatoid arthritis and other rheumatic diseases can now safely plan pregnancies by continuing their medications throughout gestation, according to new data presented at the European Alliance of Associations for Rheumatology (EULAR) 2026 Annual Meeting. A 10-year Japanese study of 118 pregnant women with rheumatoid arthritis found that 85% maintained remission or low disease activity throughout pregnancy when using a treat-to-target approach, a dramatic reversal from historical practice when pregnancy was often discouraged entirely.

What Changed in How Doctors Treat Pregnant Patients With Rheumatoid Arthritis?

For decades, a diagnosis of rheumatoid arthritis or lupus meant difficult conversations about family planning. Patients were often told that pregnancy was incompatible with their disease. Today, that narrative has shifted completely. The key change: doctors now keep patients on disease-modifying antirheumatic drugs (DMARDs), including biologic medications, throughout pregnancy rather than stopping them at conception.

The science is straightforward. When mothers maintain low disease activity during pregnancy, their babies develop normally. When mothers experience active inflammation, complications follow. "If the mother is unwell, most probably the baby will also be unwell. If the mother is okay during pregnancy, no disease activity, no symptoms, this will also help the baby to be in good condition," explained Dr. Laura Andreoli, an associate professor of rheumatology at the University of Brescia in Italy and co-chair of the EULAR Study Group on Reproductive Healthcare and Family Planning.

Dr. Laura Andreoli

Real-world data confirms this approach works. Administrative data from nearly 4,000 pregnancies in the United States showed that continuous use of TNF inhibitors (a common biologic class) during pregnancy jumped from 55% in 2011 to 73% by 2021, reflecting growing confidence in safety.

How to Prepare for Pregnancy When You Have Rheumatoid Arthritis

• Start the conversation early: Doctors should ask patients directly about family planning goals within the next year, allowing time to adjust medications and plan accordingly before conception.
• Continue biologic medications: Women should maintain disease-modifying antirheumatic drugs and biologic therapies throughout pregnancy, as stopping them increases the risk of disease flares and pregnancy complications.
• Reduce corticosteroid doses: Guidelines recommend tapering prednisone to 5 milligrams per day or discontinuing it entirely where possible, since prolonged corticosteroid use is associated with preterm birth.
• Involve multiple specialists: Shared decision-making between the rheumatologist, obstetrician, and patient ensures the best treatment plan before, during, and after pregnancy.

The evidence supporting continued biologic use is now robust. Researchers have spent more than 15 years building safety data on TNF inhibitors in pregnancy, and a recent systematic review confirmed that paternal methotrexate exposure carries no clear signals for congenital malformations, stillbirth, preterm birth, or miscarriage.

"Clinicians who take care of patients with rheumatic and musculoskeletal disease should start the conversation around reproduction and make sure that the wish of the patient is taken into account while making plans for the management of their disease," said Dr. Laura Andreoli.

Dr. Laura Andreoli, Associate Professor of Rheumatology at the University of Brescia

Why Male Fertility Has Been Overlooked in Rheumatoid Arthritis Care

While pregnancy planning for women has improved dramatically, male patients with rheumatoid arthritis and related conditions have been largely ignored. This oversight has caused real harm. One documented case involved a 37-year-old man with psoriatic arthritis whose partner's first pregnancy was terminated solely due to unfounded fears about paternal methotrexate exposure. The patient subsequently stopped his medication, sacrificing disease control and developing severe joint and skin flares alongside fertility problems.

The actual threat to male fertility is not medication, but uncontrolled disease. Swedish medical registry data showed that men diagnosed with rheumatoid arthritis, psoriatic arthritis, or spondyloarthritis before age 50 carry significantly higher baseline risk for infertility. A randomized controlled trial for the JAK inhibitor filgotinib revealed that researchers had to exclude half of male candidates before treatment began because 3 in 5 had abnormally low sperm count and 1 in 5 had abnormal reproductive hormones.

"Fear and uncertainty were bigger than the evidence that we have," said Dr. Luis Fernando Perez, a rheumatologist at Erasmus University Medical Center in Rotterdam, Netherlands, reflecting on the case of a patient whose family planning was derailed by unfounded drug concerns.

Dr. Luis Fernando Perez, Rheumatologist and Clinical Researcher at Erasmus University Medical Center

Current European and American guidelines now explicitly affirm that the majority of standard rheumatic medications are compatible with paternal use. The primary threat to male fertility is often uncontrolled disease activity rather than its treatment. Systemic inflammation from active rheumatoid arthritis can directly damage reproductive function, making disease control essential for men planning families.

What About Mental Health During Pregnancy Planning?

Despite major advances in physical disease management, one critical gap remains: mental health support. Evidence suggests that depression and anxiety are common among patients with rheumatic and musculoskeletal diseases, yet these conditions often go unrecognized and untreated during the reproductive journey. Patients report feeling isolated and anxious about family planning, even when medical evidence supports safe pregnancy.

Experts emphasize that patients should not feel alone in managing reproductive issues. "It is important that patients don't feel alone in managing reproductive issues and are reassured from the very beginning that they can speak about it with the physician who manages their rheumatic disease," Dr. Andreoli stated. The physician can refer patients to relevant specialists, with the overarching principle being that treatment decisions before, during, and after pregnancy should be a shared decision-making process.

The transformation in rheumatoid arthritis and lupus care over the past three decades represents one of modern medicine's success stories. What was once considered incompatible with parenthood is now routinely managed with safety and confidence. For patients planning families, the message is clear: modern medications and expert care make safe pregnancy possible.