Multiple Sclerosis

Multiple sclerosis (MS) is a condition of the nerves of our body.

In MS, the protective coating around the nerves, called Myelin is damaged, causing a range of symptoms.
In MS, your immune system , which normally helps to fight off infections, mistakes myelin for a foreign body and
attacks it. This damages the myelin and strips it off the nerve fibres, either partially or completely, leaving scars
known as lesions or plaques.
Once diagnosed, MS stays with you for life, but treatments and specialists can help you to manage the condition and
its symptoms.

Getting pregnant
MS does not affect women's fertility. However, some drugs used to treat MS may have an effect on the menstrual
cycle; and some medications are unsafe during pregnancy.
If you are taking any medications, and you decide to try for a baby, the usual advice is to wait at least three months
after stopping treatment before trying to conceive. It is important to discuss your medications with your doctor before
making any changes as it can be dangerous to stop taking some medications suddenly.

Pregnancy and relapses

There have been many studies examining the impact of pregnancy on MS. They all show that pregnancy appears to
have a positive protective influence, with relapse rates going down, especially during the third trimester (between six
and nine months). The reasons for this are not fully understood, but it is thought that hormone levels play a role.
However, in the first three months after the baby is born, the risk of relapse rises. This is thought to occur return to
pre-pregnancy levels.
Research suggests that these post-pregnancy relapses do not increase long-term levels of disability. In other words,
pregnancy has no effect on the progression of MS in the long-term, rather the overall effect is neutral.

Pregnancy and MS symptoms

Although women may have fewer relapses during pregnancy, other MS symptoms can be affected. Close monitoring
by the Nerve doctor and your obstetrician will be required.

Medication during pregnancy

When determining whether you should stop taking a medication during pregnancy, the doctors will look at the risks
that this would pose to you and the baby. If you do become pregnant while taking disease modifying drugs, you
should consult your doctor as soon as possible.

Pregnancy and giving birth

Having MS will not directly affect pregnancy, labour or giving birth. Several studies have shown that mothers with MS
are just as likely as any other mothers to have healthy pregnancies and babies, and there is no research to show MS
may increase risk of ectopic pregnancy (where a foetus develops in the fallopian tube), miscarriage, premature birth,
still-birth or birth abnormalities.
Having MS doesn't mean there is a need for a caesarian. Both epidurals, and anaesthetics for caesarean births, are
safe in women with MS.

What will happen after I have my baby?

Whether or not you have MS, the period immediately after the birth can be very tiring and it can take time to adapt to
the demands of having a baby to care for. For women with MS, planning to ensure there is support during this time is
particularly important.
You may wish to contact and make lists of family and friends who can help with specific tasks, and find out about
health services, local service provisions for mums and support groups. Many women find it reassuring to know local
sources of support are available, and find early planning makes life easier when the baby is born.

Children getting MS
Unlike conditions such as cystic fibrosis or Huntingtons disease, MS is not directly inherited.Children with a parent
with MS are estimated to have a two per cent risk of getting MS. In other words two out of 100 children born to people
with MS are likely to get MS themselves. The risk in the general population is one out of every 800 children.
So, although having a parent with MS increases the risk, it is still very small

MS society will help all patients during relapse and symptoms.

Rheumatoid arthritis

Rheumatoid arthritis (RA) can range from relatively mild to severe.

The outlook cannot be predicted for an individual when the disease starts.

Treatment usually includes one or more DMARDs, which aims to reduce disease activity and joint damage.
The earlier this treatment is started, the less damage is likely to occur in the joints.

Other disease-modifying medicines such as biological medicines may be used.

If you have gum disease, good oral hygiene may help to reduce disease activity.

A steroid medicine may be advised for a while to control inflammation whilst disease-modifying medicines
take effect.

An anti-inflammatory and/or other painkillers may be used to ease pain and reduce inflammation. These
help to ease symptoms but do not affect the progress of the disease. You do not need to take them if symptoms
settle.

Other treatments such as physiotherapy, occupational therapy, and surgery may also be advised, depending
on the severity of the disease and other factors.

If possible, leading a healthy lifestyle, such as not smoking, eating healthily, taking regular exercise, etc, can
help to reduce the chance of developing associated cardiovascular diseases and 'thinning' of the bones
(osteoporosis)

What is the outlook (prognosis) for

rheumatoid arthritis (RA)?
The prognosis regarding joint damage is perhaps better than many people imagine:

About 2 in 10 people with rheumatoid arthritis (RA) have a relatively mild form of the disease, and can
continue to do most normal activities for many years after the condition first starts.

About 1 in 10 people with RA become severely disabled.

About 7 in 10 people with RA fall somewhere in between with varying degrees of difficulties and disability.
Most will have to modify their lifestyle to some extent, but can expect to lead a full life.

However, these figures are probably becoming out-of-date, as treatment has improved in recent years. Symptoms
can often be well controlled with medication. Also, the outlook for a person who is diagnosed with RA these days is
likely to be much better than it was a few years ago. This is because of the newer and better medicines - in particular
the newer disease-modifying medicines. Follow-up studies of people being treated with the newer medicines should
give a clearer idea of prognosis over the next few years.

Another factor to bear in mind is the increased risk of developing associated diseases such as cardiovascular disease
(see above). Because of this, the average life expectancy of people with RA is a little reduced compared with the
general population. This is why it is important to tackle any factors that you can modify such as smoking, diet, weight,
etc.

Biologic drugs

. They are sometimes called cytokine modulators or monoclonal antibodies. Biological therapies include
adalimumab, certolizumab pegol, golimumab, infliximab, anakinra, abatacept, rituximab and tocilizumab.

They are called biological medicines because they mimic substances produced by the human body
such as antibodies. Also, they are made by living organisms such as cloned human white blood
cells. This is unlike most medicines that are made by chemical processes.

Biological medicines work in RA by blocking chemicals that are involved in inflammation. For example, some
of these biological medicines block a chemical called TNF-alpha which plays an important role in causing
inflammation in joints in RA.

One problem with biological medicines is that they need to be given by injection. They are also expensive.
Recent guidelines state that two trials of six months of traditional DMARD monotherapy or combination
therapy (at least one including methotrexate) should fail to control symptoms or prevent disease progression
before one of these newer biological medicines may be recommended. Biological medicines may also be
used in combination with methotrexate (a DMARD).

Systemic Sclerosis
Scleroderma means hard skin. If you have scleroderma, you have areas of hardening of the
skin. In one type of scleroderma, called systemic sclerosis, you can also get hardening of some
of your internal organs. This stops them working normally. There are many possible symptoms
and problems that may develop with systemic sclerosis because the extent of the disease can
vary greatly from person to person. People with systemic sclerosis should have regular
monitoring of blood pressure, blood and urine tests, and lung function, and should report any
unexplained symptoms promptly to a doctor. Systemic sclerosis cannot be cured, but there are
various treatments which can help. Newer treatments have improved the outlook for this
condition.
Systemic sclerosis is an autoimmune disease. This means that the immune system causes damage to some of the
body's own cells. Normally, our body makes proteins called antibodies to fight infections; for example, when we catch
a cold or have a sore throat. These antibodies help to kill the germs causing the infection. In autoimmune diseases
the body makes similar antibodies (autoantibodies) that attack its normal cells. In systemic sclerosis, the immune
system damages the connective tissue cells, which are found in many parts of the body. Your connective tissue
supports, binds or separates other tissues and organs within your body and can also be a kind of packing tissue in
your body. So, systemic sclerosis is also classed as a connective tissue disease.

It is not known what triggers the immune system to cause systemic sclerosis. There is probably an inherited tendency
to develop it. It may be triggered by certain germs (viruses), drugs and chemicals.

What is known is that cells called fibroblasts are affected by the immune system in some way and make too much of
a protein called collagen. The collagen gets deposited in skin, blood vessels and organs. This causes scarring and
thickening (fibrosis).

What about pregnancy with systemic sclerosis?

It is possible to have a baby if you have systemic sclerosis. You should try to plan your pregnancy at a time when the
disease is stable. Nevertheless, the pregnancy would be classed as a high-risk pregnancy because there is an
increased risk of pregnancy complications compared with women who do not have systemic sclerosis. Specialised
care from your rheumatologist and obstetrician is advisable. A rheumatologist specialises in joint and connective
tissue diseases and an obstetrician in pregnancy and childbirth.

If you are planning a pregnancy, it is important to discuss your medication with a doctor BEFORE you start trying for a
baby - because some of the medicines used to treat systemic sclerosis are not suitable during pregnancy.

What is the outlook for people with systemic sclerosis?

For most people with systemic sclerosis, the disease is either mild or moderate. For a small number (minority), the
disease can be severe or life-threatening. The outlook depends very much on which form of the disease you have,
and how it progresses. It is usually possible to make some prediction for each individual; this would need to be done
by a specialist.

As a general rule, people with the limited cutaneous type of systemic sclerosis have a milder form of the condition
which progresses slowly. People with the diffuse cutaneous type have a faster onset of the condition and its
complications, but then it will often stabilise and the skin often improves with time. Internal organs can be affected in
either type. The amount of skin involvement does not correspond with the amount of organ damage.

Although no cure has been found yet for systemic sclerosis, treatments have advanced in recent years, and the
outlook has improved. Research in this area is continuing.