About this booklet
The aim of this booklet is to help people with arthritis who are thinking about having a baby or have just found out that they are pregnant.
The general information in this booklet applies to most forms of arthritis, but there is a separate section for people who have the type of arthritis called systemic lupus erythematosus (‘lupus’ or SLE). This is because this disease behaves differently in pregnancy from other types of arthritis. See ‘Systematic lupus erythematosus (SLE) and pregnancy’.
The booklet describes the effect of the pregnancy on your arthritis and the effect of your arthritis on the pregnancy and baby. Of course, each pregnancy is different and the effects of arthritis vary from person to person, so it is only possible to give fairly general information. You should ask your doctor for more specific advice, if possible before attempting to conceive.
At the end of the booklet you will find information on how to contact the Arthritis Research Campaign (arc). There is also a brief glossary which explains medical or technical words. We have put these in italics when they are first used in the booklet.
Starting a family
When any couple starts to think about having a baby they naturally want to do all they can to have a normal healthy baby, and most couples also worry about the risk of the baby being born with abnormalities. It is no different if you have arthritis. If you plan your pregnancy and let the doctors and nurses know you are thinking of having a baby, you will improve your chances of a normal pregnancy and baby. Planning is important because of the drugs you are likely to be taking.
It is important for both partners to be fully aware of the risks and problems associated with pregnancy. Coping with a newborn baby and during the subsequent childhood requires love, time and commitment from both partners, especially when one partner has arthritis.
What supplements should I take?
All women who want to have a baby should take a folic acid tablet (0.4 milligrammes) every day from 3 months before the time of conception until 12 weeks into the pregnancy. This will reduce the risk of having a baby with a defect in the spinal canal (spina bifida). You can get folic acid from supermarkets, health food shops or chemists.
With the exception of folic acid and iron supplements you should avoid all other supplements unless a specific deficiency, such as lack of vitamin D, is found. Asian women may be particularly susceptible to lack of vitamin D due to low exposure to sunlight and a diet which is low in this vitamin (see arc booklet ‘Osteomalacia‘).
If you are taking steroids in pregnancy you may also be advised to take calcium and vitamin D tablets to help protect your bones (to help protect against osteoporosis).
When is the best time to have a baby?
Ideally, it is important to plan your baby (this is vital if you are on certain drugs such as methotrexate, cyclophosphamide or leflunomide, because you must not become pregnant or try to father a child while you are on these drugs – see ‘Drugs and pregnancy’). It is also important to discuss with your doctor the risks associated with pregnancy well in advance.
You are likely to have good and bad times with your arthritis. It is always better to try to conceive while you are in a good phase. This will allow you to reduce the drugs you need to take during the pregnancy.
Some of the drugs you are taking for your arthritis may have to be stopped before conception (see ‘Drugs and pregnancy’). This may cause your arthritis to get worse. Some drugs are safe to take in this period and your doctor will be aware of these. It should also be possible to get help in the form of other measures, such as physiotherapy and acupuncture.
As you get older (over 35 years) it may be harder to get pregnant. If you wait until you are over 40 you may have more problems with miscarrying, and will have a greater risk of having a baby with a problem like Down’s syndrome.
Any couple trying to conceive should stop smoking. This will reduce the chance of having a small baby (due to growth retardation) and will reduce the chance of a cot death. You should also cut down the amount of alcohol you drink and any recreational drugs you may use.
As mentioned earlier, every woman trying to get pregnant should take the vitamin folic acid. This is particularly important if you have ever been given methotrexate to treat your arthritis as this can affect your body’s supply of folic acid (see ‘Drugs and pregnancy’).
If you are overweight this will make it harder for you to conceive and make you more likely to develop diabetes during pregnancy. So try to lose some weight before you get pregnant. This will help your joints as well.
Should I stop all my drugs before becoming pregnant?
You should never stop taking prescribed drugs without talking to your doctor. If you tell your doctor you want to become pregnant then he/she can help to get you onto the safest combination of medication at the lowest reasonable dose to reduce the risk of the tablets causing problems. See the detailed section ‘Drugs and pregnancy’.
If I’m a man does it matter what drugs I am taking?
While many women remember to talk to their doctors about starting a family the same advice should apply to men. Some drugs you may be taking, such as methotrexate, sulphasalazine, or azathioprine, can reduce your sperm count and you may be advised to stop these drugs well before trying to father a child. Further recommendations are given in ‘Drugs and pregnancy’.
You can help improve your sperm count by eating a healthy diet, stopping or cutting down your smoking, and reducing your alcohol and caffeine intake. Remember that caffeine is not just in coffee but also in tea, coke, ‘Red Bull’ and many other soft drinks.
Arthritis and pregnancy
Will the pregnancy affect my arthritis?
The effect of pregnancy on arthritis varies with the type of arthritis. The good news is that most women with rheumatoid arthritis will be free of flare-ups during pregnancy. The arthritis will return after the baby is born, though, so unfortunately it is not a ‘cure’.
The effect of lupus (SLE) on pregnancy is outlined in a separate section. Other disorders, such as ankylosing spondylitis, may improve or become worse – there is no consistent pattern.
If you have osteoarthritis, particularly of the knee or hip, the increase in your weight as the baby grows may cause you problems.
Most women get aches and pains, particularly backache, in pregnancy and it is likely that you will too.
Will the arthritis affect my pregnancy?
Types of arthritis other than lupus do not harm the baby, or increase the risks of any problems in pregnancy. However you must always take care about the drugs you take in pregnancy, which can sometimes affect the pregnancy. See ‘Drugs and pregnancy’ for a list of the common drugs taken and what we know about their effects in pregnancy.
Will the arthritis affect my labour?
No, you should have a normal labour. If you have a lot of problems with your back, for example if you have ankylosing spondylitis, it may be a good idea to talk to an anaesthetist about whether they would advise you to have an epidural for pain relief. This can be arranged during the pregnancy, well before the time of labour. Even if you cannot use an epidural, the anaesthetist will tell you about the many other options that you will have.
For arthritis in general, there are many different positions in which you can give birth. If you have difficulty because you cannot move your legs enough in one position, the midwife will discuss with you in advance other positions which may be better.
Will I be able to breastfeed?
Yes. Breastfeeding is best for your baby so the doctors and midwives will try very hard to keep you on drugs that will not affect your baby through your milk. Drugs which are safe to use are listed in ‘After the birth’. Even if you only breastfeed for a few weeks it will give your baby a better start to life.
Will I be able to do my exercises?
Yes. It is important for your arthritis to keep exercising for as long as possible during the pregnancy. As your pregnancy advances and you gain weight you may find it easier to do your exercises in the swimming pool where the buoyancy of the water will help support your weight.
What are the chances of my child having arthritis?
As described below, this varies depending on the type of arthritis you have. With most forms of arthritis, the chances of passing it on to your children are not very high and there are many other factors involved in the development of arthritis apart from simply the genes inherited from the parents – for example, chance itself, joint injury, certain occupations, smoking, being overweight, environmental triggers and so on.
Most forms of osteoarthritis do not have a strong tendency to be passed on from parent to child. That is, in most forms, heredity plays a relatively small role compared with other factors such as age, joint injury or being overweight.
However, there is one common form of osteoarthritis which runs strongly in families – nodal osteoarthritis. This mainly affects women and causes firm knobbly swellings, called Heberden’s nodes, on the joints at the end of the fingers. Nodal osteoarthritis also often causes a swollen thumb base – that is the joint at the very bottom of the thumb, just above the wrist. Nodal osteoarthritis is almost entirely confined to white people. See arc booklet ‘Osteoarthritis’ for more information.
Nodal osteoarthritis often does not start until the 40s or 50s, around the time of the menopause, so you may not develop it while you are of child-bearing age. If your own mother has nodal osteoarthritis, and you are female, you have about a 1 in 2 (50%) chance of inheriting it yourself. And if you have inherited it, your daughters would have a 1 in 2 (50%) chance of developing nodal osteoarthritis themselves in middle life.
Although there is some tendency for rheumatoid arthritis to cluster within families, the tendency to pass it on from parent to child is not very strong (there is a slightly increased risk for a female child whose mother has rheumatoid arthritis, though an even lower risk for male children). As an example, if one identical twin develops rheumatoid arthritis, the chances of the other twin developing the disease are only about 1 in 6 (16%), and for non-identical twins the chance is only 1 in 20 (5%), about the same as for siblings (brothers/sisters). At present, information on inherited factors in arthritis is still relatively limited, but this should improve as more research is carried out. (See arc booklet ‘Rheumatoid Arthritis’.)
Ankylosing spondylitis and HLA-B27
If you have the HLA-B27 (human leucocyte antigen B27) blood cell type, you are more likely than other people to develop ankylosing spondylitis. However, about 7–10% of healthy people have HLA-B27 and never develop the disease, so this blood cell type does not automatically lead to the disease. (See arc booklet ‘Ankylosing Spondylitis‘.)
If you have ankylosing spondylitis, and are HLA-B27 positive, the chances of passing HLA-B27 to your child are 1 in 2 (50%). The risk of an HLA-B27 relative developing ankylosing spondylitis is about 1 in 3 (33%). Therefore the overall risk of your children developing ankylosing spondylitis in adulthood is about 1 in 6 (16%). However, when ankylosing spondylitis occurs in a family where other members have it, it tends to be less severe than the type which occurs with no apparent family link. Other conditions are also associated with HLA-B27 (see below).
HLA-B27 and other conditions
There are other conditions which are also associated with HLA-B27, including psoriatic arthritis and reactive arthritis. However, these are less strongly linked with HLA-B27 than ankylosing spondylitis.
Please see the separate section on this subject, ‘Systemic lupus erythematosus (SLE) and pregnancy’.
After the birth
Coping with the demands of a small baby is exhausting for any new mother, and for a woman with arthritis the stresses can be much greater. For example, people with rheumatoid arthritis often find that their arthritis flares up again in the weeks after the birth (often after going into remission during the pregnancy) and this can obviously make things more difficult. You should try to counteract this by arranging beforehand for extra help after the birth from family and friends. If necessary, extra help can be arranged – discuss this with your doctor or with social services.
Once the baby is born, a physiotherapist and occupational therapist may need to be involved in the aftercare, as holding, dressing, washing and feeding a baby – particularly night feeds – can all be difficult because of stiffness. Your doctor should be able to tell you whether you can get help of this sort and how to go about it. If you already have another small child or children, you will need to arrange for extra help in caring for them. Extra support from a partner, other family members or friends is crucial in sharing the care of a small baby, while help from extended family and social services will all help you cope in the first few months after the birth.
Having a small child can be hard work, even with help from a committed partner and other family members. But a good number of women with arthritis, including rheumatoid arthritis or lupus, are still capable of having children and can often do so without too many problems.
If your drugs for arthritis were stopped before or during the pregnancy most doctors recommend going straight back on to them. This applies except where the drugs would stop you breastfeeding (see below). Because of the benefits for the baby of breastfeeding, at least for the first few weeks, in the case of certain drugs some people prefer to wait until the arthritis flares up again before returning to medication. Ask your doctor or rheumatology nurse for advice on this matter.
Drugs you are taking while breastfeeding may pass into the breast milk, although in small amounts, so it is sensible to take as few drugs as possible. Many drugs (particularly many of the disease-modifying anti-rheumatic drugs (DMARDs) such as cyclosporin, gold injections, cyclophosphamide, methotrexate and leflunomide) must not be taken at all while breastfeeding – if these drugs are necessary then the baby should be bottle-fed. Sulphasalazine and hydroxychloroquine have been used successfully in women who were breastfeeding.
Most non-steroidal anti-inflammatory drugs (NSAIDs) do not enter the breast milk in large quantities, except high-dose aspirin and this should be avoided. Drugs such as ibuprofen, indomethacin and diclofenac can be used but doses should be kept to a minimum. If you are taking steroids, small amounts are excreted in breast milk, but no side-effects on babies have been reported. See ‘Drugs and pregnancy’. More information is given in arc leaflet ‘Drugs and Arthritis’ and in individual arc leaflets on each drug type.
If you have a flare-up during the time after the birth, perhaps before the DMARDs have had a chance to start working again, then your doctor may give you a short course of steroids. If only one or two joints are troublesome these can be safely injected with steroids. Other measures that may be of use include physiotherapy.
Systemic lupus erythematosus (SLE) and pregnancy
Will the pregnancy affect my lupus?
It is difficult to give advice that is appropriate for everyone as the disease can vary from mild to severe. Some people with severe lupus may be advised against pregnancy as pregnancy can put an enormous strain on your heart, lungs and kidneys. For other women it may be safe to proceed under careful supervision. To repeat, it is best to discuss this before conception with your doctor or nurse specialist.
The good news is that most women with SLE will conceive while in a quiet phase or ‘remission’. You may stay in remission or get flare-ups during pregnancy. However, some types of flare-ups (those involving skin and joints) tend not to occur towards the end of pregnancy.
There are many drugs that can be safely used in pregnancy to treat your flare-ups. These include steroids and a drug called immunoglobulin, but others have also been successfully used – see ‘Drugs and pregnancy’.
Will the lupus affect my pregnancy?
Most women with SLE will have a successful pregnancy. However, some women with SLE do have a higher risk of having a complicated pregnancy. This will mean close monitoring at the hospital and your obstetric consultant will need to see you frequently in the antenatal clinic. Miscarriage affects between 1 in 4 and 1 in 5 of all pregnancies in the general population, so it is very common. There appears to be an even higher risk if you have SLE. The miscarriage may also be slightly later than the ‘normal’ miscarriage (which usually happens by 12 weeks) – up to 24 weeks if you have antiphospholipid syndrome. For details of antiphospholipid syndrome in people who do not have lupus, see the separate arc booklet ‘Antiphospholipid Syndrome’).
It is preferable if the pregnancy is planned, as this will allow your lupus specialists and the obstetric team to work closely together. It may be that they advise you not to have your baby at your local hospital but at a more specialist site where they can work better as a team to help you. It is important to be in a hospital that is able to look after very small babies. This means that a baby born early or very small will have the best chance of surviving.
You and your baby will be checked more often than most women. You will have regular scans to check how your baby is growing. The medical team will also use other ways of monitoring your baby which may include taking regular traces of its heartbeat and checks on the blood flow to the womb and the umbilical cord (using ultrasound scans). Your blood pressure and urine will also be checked.
You must always take care about the drugs you take in pregnancy. However, the risk of a problem to the baby may be greater if you do not take the drugs or if you stop them suddenly.
What types of problem can happen later in pregnancy with lupus?
- an increase in your blood pressure (pre-eclampsia)
- your baby may not grow as fast as normal (growth retardation)
- your waters may break much earlier than usual or you may go into labour early (a pre-term delivery).
There is some evidence that a low-dose aspirin tablet taken every day can reduce the risk of you developing some of these problems. Your doctor will discuss this with you when you first go to the antenatal clinic.
If your kidneys are affected by the SLE and you already have high blood pressure before the pregnancy, you have more chance that these problems may occur.
The problems listed above are more likely if blood tests show that you have antiphospholipid syndrome. Women with this condition will usually see a consultant with a particular interest in ‘high-risk’ pregnancies (see arc booklet ‘Antiphospholipid Syndrome’). You will be given a low-dose aspirin tablet every day, but you may also need daily injections of a blood-thinning drug (anticoagulant) called heparin. This does not cross the placenta so does not affect your baby. You can easily be taught to give this injection yourself.
Will the lupus affect my labour?
No, you should have a normal labour like most women. However, if you go into labour too early, the doctors may try to stop you labouring, with drugs, to allow more time for the baby’s lungs to mature. However, because you have a greater risk of problems during your pregnancy, there is also a greater chance that the doctors may feel that it is safer (for you or for the baby) for the baby to be delivered by Caesarean section. This would be discussed with you during the pregnancy well before the time of labour.
Will the lupus affect my baby?
Babies born to mothers with SLE do have an increased risk of being born smaller. If so, your baby may need to spend a few days in the neonatal nursery. If the baby is born very early, he/she will spend longer in the nursery and may need help with breathing initially.
If you carry Ro antibodies in your blood, there is a chance that your baby will develop an abnormality called congenital heart block. Only a few women with these antibodies will have this problem. Your doctor will carefully monitor your baby’s heartbeat, which can become quite slow during the pregnancy. It is possible that steroid tablets may help prevent this complication but medical trials are still underway. On the whole, babies affected in this way usually do very well but may occasionally need to have a heart-pacing device inserted after birth.
What are the chances of my child having lupus?
There is a small chance of your child developing lupus in later life if you have it yourself, perhaps 1 in 100 (1%) altogether.
Because of the way the genes involved work, there is actually a greater risk of other relatives developing the disease. For example, the risk of developing the disease if you are the sister of someone with lupus is about 1 in 33 (3%). The risk is lower for brothers.
If you carry Ro antibodies in your blood, there is a 1 in 20 (5%) chance that your baby could develop a problem called congenital heart block, which can be monitored for during the pregnancy. More information is given in the previous section.
Drugs and pregnancy
Every couple hopes that they will have a perfect baby. In an ideal world the process of having children, from conception to breastfeeding, would be drug-free. This is because we can never be 100% sure that the drug will be harmless to the developing child. In fact, most drug manufacturers recommend that their product is avoided (or at least warn against using their drug) during pregnancy. However, in order for the pregnancy to have a successful outcome, for both mother and baby, sometimes drugs are essential. This is the case for many of the drugs used in people who have arthritis. We do know that, for most drugs, many women will take the drugs during pregnancy and still have normal babies.
Most drug information leaflets (those found in the package with the tablets) and the arc drug information leaflets will advise you not to take the drug during pregnancy. That is not the same as saying that the drug will definitely harm your baby. Discuss each drug you take with your doctor or specialist before you try to become pregnant.
Scans to check for problems
An ultrasound scan, to check for abnormalities in the baby, is done in all pregnancies at 18–20 weeks. The doctors choose this time because the baby is bigger and it is easier to find any problems then. Some problems can be quite minor. If any problem is found at your 20-week scan, the doctors and midwives will talk to you about it and discuss the implications and options available to you. More detailed scans may be necessary if, for example, you have taken tablets or drugs during the pregnancy that may cause particular problems.
Sometimes you may need two or three scans before the doctors can see everything clearly but this does not necessarily mean that there will be a problem. Babies can hide the parts we are trying to see with their hand, for example. So do not worry if everything cannot be seen clearly at first and you are asked to return for a second scan.
This is recommended in pregnancy and it is used as a good form of pain relief. Use the same dose as you would use when you are not pregnant. If your kidneys are not working properly you may be told to use a lower dose.
Non-steroidal anti-inflammatory drugs (NSAIDs)
The NSAIDs include aspirin, ibuprofen, indomethacin and other drugs. NSAIDs do not cause abnormalities in the baby. However, they may reduce the amount of fluid in the womb that surrounds the baby.
Large doses of NSAID tablets given to women towards the end of pregnancy may cause a blood vessel in the baby’s heart to close early, while the baby is still in the womb, rather than at birth. (This blood vessel is the one which redirects the baby’s blood to allow it to get oxygen from its lungs, rather than from the placenta.) If this does happen, the problem will usually resolve completely if the NSAID tablets are stopped. Nevertheless, it is best to be on the lowest dose of NSAID tablets that will keep your symptoms controlled. You may be asked to reduce or stop your NSAIDs towards the end of pregnancy for this reason. NSAIDs might also be stopped during delivery as they may prolong the labour and cause excessive bleeding during delivery. Please note that the ‘low-dose’ aspirin tablets taken throughout pregnancy by women with SLE do not have this effect on delivery or the effect on the blood vessel in the baby’s heart.
A common problem with NSAIDs is indigestion, which is also common in pregnancy. Antacid medication usually helps, but if it is very troublesome you should tell your doctor.
These are often used in pregnancy. There is no evidence that steroids harm your baby and doctors often use them in pregnancy to mature the baby’s lungs (usually when labour happens before 34 weeks). The steroids may also cause you to be at a slightly increased risk of developing diabetes of pregnancy (high blood sugar levels). This is easily detected by checking your urine sample – and usually goes away again when the steroids are stopped.
If you have been on high doses of steroids for a long time you may be given an extra boost of steroids during labour to help your body cope with the stress of labour. This is routine for anyone taking high-dose steroids for a long time.
Women taking steroids throughout pregnancy may be advised to take supplements of calcium and vitamin D to help prevent thin bones (osteoporosis).
Azathioprine (e.g. Imuran)
This can lower the sperm count in men and, for women, it may also affect the eggs. Many women who have had renal transplants take azathioprine. So far, they appear to go on to have normal babies with no increase in the risk of abnormalities.
D-penicillamine (e.g. Distamine)
While there is a risk that this could cause a problem if taken in high doses in early pregnancy, a number of women have had a successful pregnancy while taking this drug. However, it is not generally recommended.
Hydroxychloroquine (e.g. Plaquenil)
This drug is frequently taken to prevent malaria and so far it has not caused an increased risk of birth abnormalities in higher doses. It has been successfully used in lupus.
Sulphasalazine (e.g. Salazopyrin)
This can cause a low sperm count – if a man has difficulty trying to start a family it might be better changing to another treatment. It is used for bowel disease as well as other types of arthritis. Many women have taken this drug and had successful pregnancies.
This affects both eggs and sperm. It can also cause miscarriage, or abnormalities such as spina bifida in the unborn baby. Methotrexate must not be taken while you are pregnant or breastfeeding and it should not be taken for at least 3 months before you try to become pregnant or father a child. Reliable contraception is therefore essential while you are on methotrexate (whether you are male or female). If you become pregnant while on methotrexate, talk to your doctor as soon as possible.
Cyclophosphamide (e.g. Endoxana) and chlorambucil (e.g. Leukeran)
These are likely to cause harm and should be avoided during pregnancy. Cyclophosphamide and chlorambucil can cause sterility, in men and women. However, both these drugs can be life-saving treatments. Men having these treatments may be advised to collect and ‘bank’ sperm for future fertility.
Gold injections do not appear to affect fertility. Although the drug does cross the placenta, there have been no reports of damage to the baby. Gold is excreted in the breast milk and may cause a rash and kidney problems in the baby, so women who wish to continue with this drug should use bottle-feeding.
Cyclosporin is used widely in people who have had a transplant and many successful pregnancies have been achieved in women who had to take this drug during their pregnancy. However, the drug is excreted in breast milk and bottle-feeding is therefore advised.
This is a relatively new drug used in rheumatoid arthritis. There have already been a few reports of successful pregnancies with no ill effects noted but further experience is needed.
This is also a relatively new drug used in rheumatoid arthritis. The current practice is that this drug has to be given along with methotrexate, so the rules and warnings for methotrexate apply.
Again a relative newcomer in the treatment of rheumatoid arthritis. Leflunomide may cause birth defects and should be avoided. Leflunomide stays in the body for a long period of time and women wishing to get pregnant should allow at least 2 years from stopping this drug to trying to conceive. For this reason doctors sometimes avoid using it in women who may want a pregnancy. Reliable contraception should be used when taking this drug.
Antibodies – blood proteins which are formed in response to germs, viruses or any other substances which the body sees as foreign or dangerous. The role of antibodies is to attack the foreign substances and make them harmless. However, in certain diseases (called autoimmune diseases) antibodies can attack the body’s own tissues – these are called autoantibodies.
Antiphospholipid syndrome (APS) – Antiphospholipid syndrome (APS) is a disorder in which the blood has a tendency to clot too quickly (‘sticky blood’ syndrome). The clotting can affect any vein or artery in the body, resulting in a wide range of symptoms. It is caused by an antibody which ‘attacks’ phospholipids. Phospholipids are found throughout the body, particularly in the outer coating of cells, such as the white blood cells called platelets. Because the antibody attacks the body’s own cells, rather than bacteria, it is called an autoantibody. APS can occur in lupus or on its own – see arc booklet ‘Antiphospholipid Syndrome’.
Conceive – Fertilisation of the female’s egg by the male’s sperm and successful implantation of this fertilised egg in the womb.
Conception – the process of conceiving.
Diabetes – the most common form is properly called diabetes mellitus. This is a condition in which the body cannot process (metabolise) sugar properly. Although it can happen in association with pregnancy, when it does it generally goes away after the baby is born.
DMARDs – disease-modifying anti-rheumatic drugs (also known as ‘second-line’ drugs). This group of drugs includes sulphasalazine, penicillamine, gold, hydroxychloroquine, methotrexate and many others.
Epidural – an injection given into the space around the spinal cord to anaesthetise the lower half of the body. The full name is epidural blockade.
Neonatal – newborn.
NSAIDs – non-steroidal anti-inflammatory drugs. Examples are ibuprofen, diclofenac and indomethacin but over 40 types are available.
Pre-eclampsia – a common condition in the second half of pregnancy in which three things occur: high blood pressure, protein in the urine, and fluid retention. Pre-eclampsia occurs more commonly in first pregnancies.
Pre-term delivery – when the baby is born before 37 completed weeks of pregnancy.
Ro antibodies – a certain type of autoantibody found in lupus and also in a disease called Sjögren’s syndrome (see separate arc booklets on these conditions). Ro antibodies have been associated with congenital heart block (see ‘Will the lupus affect my baby?’).
Spina bifida – a defect in the spinal canal which can cause damage to the nerves to the legs.