Hi L.,
Let me preface this by saying that this is a very personal decision and that autoimmune diseases differ enough from person to person that I think your best bet is to listen to your gut instincts. I do not have RA, but I do have multiple sclerosis. I had a big flare when I was pregnant and that's when I was diagnosed. However, many people believe that you are less likely to flare w/ an autoimmune disease while pregnant (and more likely post-partum, with the chances during the year as a whole being just the same as any other year according to my doc). When I spoke to him (and he is a leading MS expert), he told me he had no concerns about my being pregnant again but that I should consider my fatigue levels in relation to having two kids. He did not discourage me from having a second child; he just pointed out what he believed would be my biggest challenge. I have extreme fatigue related to the MS, and, from what I hear, having two kids is exponentially more tiring than having one. For that reason (and because my first child came 11 weeks early - he's fine), I decided not to have another child. I need all my energy for the child I already have. That being said, I don't know your specific symptoms and if how severe they are. If I did not have severe fatigue (at least without my meds -- with meds, I'm able to function, though not at the same level I did before) I would probably have had another child, even knowing that I flared the last time I was pregnant. I guess what I'm trying to say is that, for me, I had to assess how having two kids would affect my health and my ability to interact with my kids. For me, the fatigue was too big of a problem, in terms of both my ability to be avialable as a mom and the potential that the extra fatigue would lead to more flares. If I did not have extreme fatigue and was only looking at potentially flaring during pregnancy (not that flaring is a minor issue, and I in no way mean to minimize the significance of an RA flare), I would have had a second child. Talk to you doc, and think about your specific course of RA and how your body will respond to the extra demands of having a second child. If you are doing really well on your meds and will likely be fine once you're back on them, I would say go for it! Again, though, only you and your doc can assess your experience with RA and think through how you will feel while pregnant and then afterwards with the extra demands of a second child. Somewhere, your gut instincts probably know the answer. The tough thing is to quiet the fear of what might happen and allow those instincts to speak more loudly than the fear so that you know which one you're listening to!
I just saw the post about myofascial release (sometimes known as trigger point therapy), and I completely agree that it's amazing. I also have fibro, though I was a competitive athlete my whole life and have significant wear and tear on my body from that, and myofascial pain therapy has been a life saver. I have no idea what effect it would have for RA pain, as my understanding is that RA pain is caused my inflamation in your joints, but if you get muscular pain, it's worth a try! My husband actually bought the text book, and the practitioner showed him how to find trigger points so that we would not go broke paying the professionals!
K.