I checked my lactation texts. I couldn't find anything specifically about
synovitis variant of juvenile rheumatoid arthritis, but thought these quotes
might be of help.

On pages 527-528 of Breastfeeding A. Guide for the Medical Profession, 5th
Ed.
 Lawrence states:

The influence of lactation on the development and progression of rheumatoid
arthritis (RA) has been the subject of several epidemiologic studies.
Previous observations noted an increased risk of RA developing postpartum,
particularly after the first pregnancy. A national cohort of 187 women
developed RA within 12 months of pregnancy. Of the 88 women who developed the
disease after their first pregnancy, 71 breastfed (81%) compared with only
half the control mothers. A smaller risk was noted after the second
pregnancy. No added risk with the third pregnancy was associated with
breastfeeding. The increase in risk was highest in those women whose disease
was erosive and rheumatoid factor positive. The authors suggest that this may
be a hormonal influence, especially by the proinflammatory hormone prolactin.

Other investigators reviewed a cohort of 176 women with RA who had at least
one child and a mean age of 46 years at diagnosis. They concluded that parity
and to a lesser degree breastfeeding before RA onset worsened the diagnosis
for severe disease. Oral contraceptive use had a protective effect.

The evidence regarding reproductive events as risk factors for RA is
conflicting. A population based study of 63,090 women followed from 1961 to
1989 examined reproductive factors and mortality ratios. The role of parity,
age at first and last birth, or age at menarche and menopause showed no
relationship to RA. A protective effect of lactation was noted, however, with
total time of lactation associated with decreased mortality from RA with a
dose-response relationship.

Rheumatic disease may necessitate treatment of pregnant and lactating
patients with disease-modifying active rheumatic disease (D-MARD) drugs or
immunosuppressive drugs. For lack of information, breastfeeding is not
recommended by Ostensen in patients requiring antimalarials, penicillamine,
cyclosporine, or cytotactic drugs. On the other hand, intramuscular gold and
sulfasalazine impose no risk to the breastfed infant.

References:
Brennan P, Silman A:Breast-feeding and the onset of rheumatoid arthritis,
Arthritis Rheum 37:808, 1994
Jorgensen C, Maziad H, Bologna C et. al. Kinetics of prolactin release in
rheumatoid arthritis, Clin Exp Rheumatol 13:705, 1995
Jorgensen C, Picot MC Bologna C et. al. Oral contraception, parity,
breastfeeding and severity of rheumatoid arthritis, Ann Rheum Dis 55:94, 1996
Brun JG, Nilssen S, Kvale G: Breastfeeding, other reproductive factors and
rheumatoid arthritis: a prospective study. Br J Rheumatol 34:542, 1995
Ostensen M: Treatment with immunosuppressive and disease modifying drugs
during pregnancy and lactation, Am J Reprod Immunol 28:148, 1992

According to Riordan & Auerbach in Breastfeeding and Human Lactation, 2nd
Edition, p. 558-559:

Rheumatoid arthritis (RA) is a chronic inflammatory disease thought to be
caused by a genetically influenced autoimmune response. Symptoms include pain
and swelling of the joints, pain on movement and fatigue. RA symptoms usually
go into remission during pregnancy and then relapse postpartum. The problem
is greater for breastfeeding women, probably owing to their hyperprolatinemic
state; prolactin has been shown to be an immunostimulator (Brennan & Silman,
1994.)

NSAIDs are used as a first-line therapy to decrease pain and inflammation.
Due to their erosive effect on the gastrointestinal tract, the mother also
may be anemic from blood loss. Methotrexate therapy, used for severs cases,
is contraindicated in breastfeeding, according the American Academy of
Pediatrics. However, only very small amounts of this drug are secreted into
breastmilk (Hale, 1997). Women with RA often feel overwhelmed with fatigue
both during pregnancy and postpartum (Carty, et. al., 1986). If the mother's
hands and fingers are stiff, breastfeeding is easier than is artificial
feeding, which requires more complex movements. Although this mother needs
additional rest, she still needs to continue range-of-motion exercises.
Periodic rest periods and the wearing of removable braces or splints to
support joints will help to reduce fatigues. (Carty, Conin, & Hall, 1990).

Hope this is of use.

Kathy

Kathleen Fallon Pasakarnis, M.Ed. IBCLC
Nurturing Family Lactation and Parenting Services

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