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  • Psoriatic Arthritis and Breastfeeding

    Hi!
    I'm a LLL Leader with a question about breastfeeding and the treatment of psoriatic arthritis.

    The suggested treatment is six 2.5mg tablets of methotrexate once a week for severe psoriatic arthritis. Is there any way this can be compatible with nursing a 3 year old, even just a few times a week, or is weaning necessary? Is there an alternative to this medication?

    Thank you for your time!

    Amanda Steyer
    Leader
    LLL of Naugatuck Valley, CT
    Amanda.S@lllct.org

  • #2
    Amanda:

    It always comes down to risk vs benefit. After 3 years, the benefit is still wonderful, but physiologically minimal. In this case of 15 mg per week of methotrexate, the potential risk to the infant could be high if the mom were to breastfeed within 24 hours or so of the dose. Even after that, some of the mtx would still be in milk.

    I'd sugggest she discontinue breastfeeding with this drug. Methotrexate is known to concentrate heavily (ten fold) in the gut of infants...hence my worry about this drug.

    Other possible therapy would include: Sulfasalazine, leflunomide, cyclosporine, etanercept, infliximab and adalimumab. But the therapy for this syndrome is tricky, and the physician's skills should be relied upon for the proper choice.

    Tom Hale Ph.D.

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    • #3
      Hi, I was diagnosed with psoriatic arthritis (affecting jaw, spine, left elbow, both hands and wrists, thumbs and little fingers, pelvis, right knee and right foot). I was severely disabled by it and on DMARDS with only a small improvement with the drugs. I was fortunate to be directed to Dr Horst Mueller who was able to help me reduce my inflammatory markers to almost normal levels (and I expect complete resolution in time) over a couple of months - with NO MEDICATION. I am happy to give you his email if you would like it. It does not involve any cost - no supplements/medications and he gives his advice free of charge. What he does teach is how the mind and emotions affect disease. It was a very big paradigm change for me because I have a background in conventional health/medicine (I am a nurse/midwife and lactation consultant). All the best.

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      • #4
        Dear Dr Hale team,
        I do have a related question: I do have psoriasis and most likely psoriasis athritis too. My baby daughter is 8 months old and nursing at least 5x per day. Are there any treatment plans that I could hope to start before I wean her completely? Before my pregnancy I had a vitamin D derivative containing ointment that helped after some cortisone cream. Could this or something similar work at least for my skin problems?
        Thank you!
        Sibylle

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        • #5
          Grunersi: I think you should talk with your physician first about recommended treatments in your condition. Then we can help with the breastfeeding issue.

          Tom Hale Ph.d.

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          • #6
            So here's my dermatologist's treatment plan: 2x per day 'vobaderm' cream containing flupredniden-21-acetat (1mg per 1g cream) and miconazolnitrat (20 mg/1g) on the vulva area ca hand sized area for a few days (max 7 days) then calcipotriol a vitamin d3 analogous. He also send me to a rheumatologist. This appointment will be in a few weeks. So, what do you suggest with the vobaderm. I know corticosteroids and antimykotika can get in my milk. My baby is 8 months old and still nurses a lot. Longest gap between feedings is 6-7 h @ night. Normal daytime intervals 3-4 h, sometimes more often.

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            • #7
              Grunersi:

              Neither this topical steroid, or the topical miconazole would be contraindicated in a breastfeeding mother. Corticosteroids for some reason don't enter milk very well even when are injected, much less via the skin, and it beneficial that this is for short term use. Miconazole is commonly used by breastfeeding mothers all the time, in high doses orally. Very little will be absorbed through the skin.

              Lastly, the fact that your infant is 8 months old is beneficial, as she can handle most any drug quite effectively.

              Tom Hale Ph.D.
              Professor


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              • #8
                Dr Hale
                Please help me, i had psoriatic arthritis, and my baby is 2 months now,can i take enbrel 50/week safely? Iam afraid baby will be affectedwhile breastfeeding
                Are there statistics that says no harm on baby?
                Last edited by Mhelo; 02-09-2019, 11:02 AM.

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                • #9
                  Mhelo,

                  Enbrel is rated an L2-limited data-probably compatible, The amount that transfers into breast milk is only 0.07-0.2% of your dose. "Three studies in breastfeeding women confirm that levels in milk are exceedingly low. No untoward effects were reported in any of the infants. Etanercept was undetectable in infant plasma. All the authors suggest it should be quite safe for breastfeeding mothers and their infants." (Medications and Mothers' Milk database, Dr Thomas Hale PhD).

                  Sandra Lovato R.N.
                  ​​​​​​​InfantRisk Center

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