Advice needed please!

[Jess136]

Hi everyone, I'm new to this forum and would love some advice as I'm in a difficult situation. I was diagnosed with RA this summer but at that point my symptoms weren't really too bad, stiffness in the morning and some pain but nothing too extreme. I'm 31 years old and also a type 1 diabetic, insulin controlled for the last 25 years and I think I manage it pretty well, I regularly check my blood and eat sensibly. So after receiving the RA diagnosis my GP, rheumatologist and diabetes nurse all advised me that if was thinking about having kids, to do it sooner rather than later and to hold off on taking the RA medicine if I thought I might try to conceive in the near future. So this is where it becomes tricky: i live in Thailand as my husband is Thai and we run a restaurant together here, we are not usually based in the UK although I come back for a few months every year. I returned to Thailand at the end of October and I'm now pregnant! About 6 weeks so it's very early still. Unfortunately my arthritis has become REALLY bad, particularly in my hands, wrists and weirdly my upper arm?! I'm finding it difficult to sleep and it's preventing me from doing 'normal' things like drive, cook etc. I know it's common for women to go into remission when pregnant but is it usual for it to be so bad in the beginning of a pregnancy? I'm terrified that it's not going to improve and understand I'm not really supposed to take painkillers other than paracetamol (which doesn't really seem to help much sadly). I emailed my rheumatologist in the UK and he advised that I could take Prednisolone, starting on 20mg and gradually reducing over time to 5mg a day. I spoke to a doctor here in Thailand about this and he said he would not advise this at all, plus he said I had a much higher risk of preeclampsia as it is my first pregnancy, I'm type 1 diabetic AND now I have a second autoimmune condition. I really am at a loss as to what to do; I don't want to anything that could potentially harm the baby but I'm also worried that being in this much pain can't be good for the pregnancy either? I don't really have a doctor here who I trust or I feel gets the whole situation, on my last visit I was told it was up to me to manage my diabetes and my pregnancy, they would not provide any extra support or checkups as I had to control it myself. I'm just feeling a bit overwhelmed and very tired so any advice would be so so welcome! Have any of you used Prednisolone during pregnancy? Is it safe so early on? Should I just try to grin and bear it and hope it improves in the second trimester?? Thank you in advance!

[Philing]

Its a difficult situation you are in. The risk is harm to the baby from the meds and its long term health. I suppose you could wait it out and hope it gets better but I can only suggest you get a third opinion qho might steer you to less harmful but probably less effective interventions. Hopefully things settle down a bit for you.

[helixhelix]

I too would search around for another specialist in Thailand - long distance medicine isn't really brilliant and if you are planning to be there in the long term you will need one.

Hopefully this is early days, and very shortly the pregnancy hormones will kick in and your RA will calm down. I hope so as sounds stressful.

I would also encourage you to work out your medical cover longer term as with a new baby you need to be sure you have access to medical services. If you are only in the U.K. a few months a year you may find your residential status being questioned and your access to the NHS removed. I'm not trying to scare you, but with Brexit looming things are getting tighter about ensuring only permanent residents can get free access to the NHS.

[janmary]

Hopefully your flare is just temporary - maybe associated more with change of climate/activity/ rather than pregnancy. But management of pregnancy with diabetes alone is usually seen as needing specialist care, so do take care - have you got a diabetes doc in the UK who can give you some advice ? will the baby be born in Thailand or could you come back to the dear old NHS and find a maternity unit which specialises in more complex pregnancy?

[stel4]

From this article it seems low to moderate dose prednisolone is safe in pregnancy

nras.org.uk/rheumatoid-arth...

[Hidden]

Congratulations on your expected baby!

Sorry about your situation though; others have posted good suggestions, so I hope those help.

I have family in Thailand, about 1.5 hrs SE of Bangkok. They have good healthcare package as part of their work contract.

Hope you can get yourself properly provided for soon, too.

[Jess136]

Thank you to everyone that replied, I really appreciate it. No I don't qualify for NHS treatment anymore, apparently anyone that spends more than 3 months out of the UK in a year will no longer qualify, so I'm already managing my diabetes from here and as I've had it for so long I'm very used to it. I saw a rheumatologist privately when I was in the UK this summer and I also saw one in Bangkok at the international hospital there when I flew back in October, but at that point I didn't know I was pregnant. The rheumatologist in Bangkok told me it was fine to take hydroxychloriquine when trying to conceive and during pregnancy but this went against what I'd been told in the UK. A lot of the international hospitals here have a very high quality of care, but they're not always so great at being reassuring or offering peace of mind when you're feeling uncertain about the right choices to make! I guess I will try to make the best of it for now and if it really doesn't improve I will travel back to Bangkok or phuket to seek another specialist's opinion. Thanks again.

[helixhelix in reply to Jess136]

Don't overlook relief the non-medical aids can offer. May only be temporary, but can raise spirits. So wheat bags and wax baths for your hands, plus wrist supports. A maternity body pillow can help you support aching bits to be able to sleep more easily, and also your back/bump once it gets big enough. And some people do find simple things like perneton gel very soothing on aching hands. You want to be able to enjoy your pregnancy and the anticipation as much as you can.

[Simba1992]

Congrats to your pregnancy😊I really do hope the kicking in of pregnancy hormones will change the situation with RA pain, as it so often does. I can only imagine how stressful it may feel not to have a doctor you can trust. One thing that came to my mind and that may be of help for pain. A well known fact seems to be that diabetes and low thyroid function are often linked. Hypothyroidism does make RA symptoms worse. This is one thing you can have checked and taken care of if needed without having to worry about med toxicity. Here is a bit of reading you might find usful😊Simba

thediabetescouncil.com/the-...