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hello,
I’m a rhematoid pt and an AP user . I was having difficulty getting pregnant, but I’m now 4 months pregnant .I was on solupred 10 mg/day , clindamycin IM and oral vibramycin before pregnancy and I stopped all antibiotics when I found out . Everything was going ok until I took the toxoplasma IgM test it was 1.11 (<1.0 is +ve)so i took spiramycin (rovamycin) 3000000 u 3 times/day for 3 weeks then took the IgM test again it was 1.86 . I talked to my ob doctor and she told me to take the spiramycin course again and so I did , then the IgM came out 3.52 and the IgG was negative. when I was on the spiramycin course I had constant arthritis because there was no interruption between doses . my questions are do I have toxoplasma infection or not???? could the IgM be false positive ??? what about mycoplasma ?? do they have serious adverse effects on my fetus ?? should I be back on antibiotics while pregnant??? I’m from Egypt and rheumatologists and ob doctors know nothing about rheumatoid-mycoplasma complex and I’m following this protocol on my own and there is no one here who can help me or answer my questions.
P.s I’m also a physician (dermatologist)Hi Diddy,
Long time, no see! You must be very excited about your soon-to-be new arrival – many congrats!
As we are just patients here, we can’t really offer any medical advice or tell you the significance of your test results, but as a mother of two children, I think I’d err on the side of caution if it was me. The following study on pregnant women with toxo concludes that treatment during pregnancy can significantly limit the chance of negative sequalae in the newborn infant, though it may not eradicate the potential for maternal transmission to the fetus. So, speaking as a mother, I’d continue to take antibiotics that were safe during gestation, for the full duration of my pregnancy, just to protect my child.
https://www.ncbi.nlm.nih.gov/pubmed/9988811
It’s a weird thing, but with other infections, people here have reported negative baseline results with testing, but once treatment begins, the underlying chronic infection is revealed. I don’t know why this is and can only speculate that some infections are immune-suppressive and, once the pathogen load is reduced, the immune system is more capable of seeing a chronic infection and starts mounting enough of an antibody response to show up on indirect testing methods. Another theory – treating the infections may have some biofilm-busting effect. I have also heard of people being told that their positive infection results are false positives, without any further testing to confirm this proclamation, which sounds a bit like woo-woo medicine to me. Why run a test to see if there is infection and then tell a person it’s a false positive result? Why would anyone want to rely on any test that was that insensitive or non-specific?
Just my lay take, diddy, but I wouldn’t take any risks during pregnancy and would want to treat prophylactically, especially if the risk-benefit favors benefit over risk with the use of the antibiotics.
Another consideration is that there are a number of antibiotics that are safe to use during pregnancy and it’s not unusual for women to have a post-partum flare, due to the crash in hormones that naturally occurs when pregnancy ends. I’ve read that the high levels of hormones during pregnancy are nature’s way of maintaining the pregnancy and to help to prevent fetal rejection. In effect, pregnancy simulates immune-suppression. So, for the rheumatic mother’s own health, to remain on AP during pregnancy can help to prevent chronic infections from proliferating in an immune-suppressed environment. There was a Mom here, who was expecting twins, and she had scleroderma and chronic Lyme. She switched from tetracyclines to other antibiotics that were safe for use during pregnancy – her SD did not relapse and she delivered two very healthy babies – twins! Here is a link to the discussion thread where she visited the forum to announce her babies’ arrival!
https://www.roadback.org/forums/topic/introducing-my-miracle-twins/
I hope this helps, Diddy. Would you like the contact info of Dr. S. to contact him to ask which antibiotics he’d recommend for you for toxoplasmosis during pregnancy?
Thank you very much for the reply it was very informative and of course I’d like to contact Dr.S about my condition.
Hi Diddy,
Just sent you a PM…to locate it, just place your cursor over where it says, “Hello diddy,” of your screen and then select Messages/Inbox, or just click on the automated private message email you receive. Have included some additional resources in hopes they might help. Wishing you the very best!
Hi Maz ,
Thank you for all the guidance you have given me through that horrible crisis with toxoplasma . I want to keep you updated about my situation hopefully this can be helpful to other future mothers with Rh. I’ve taken the IgM and IgG tests in another lab and both of them came out negative ,so I’m Thinking that the IgM kits in the previous lab was not specific for toxoplasma . Anyways I took a PCR test ( which detects the DNA of toxoplasma ), and I’m waiting for the result.I’ve emailed Dr.S but he has not answered . I wanted to ask him about the safest antibiotics I can take during pregnancy as I wanted to benefit from PetRescue experience with AP and its regimen during pregnancy . I hope You can provide this information for me as I can’t reach him.
I also want to add my experience with Rh remission during pregnancy which should be up to 70% of cases. To me this remission was a big lie told by every rheumatologist I’ve seen . Before pregnancy I was in remission with the AP then I started to get arthritis attacks by the time I had a “missed period” , the first trimester was awful ,I was almost bed ridden in addition to taking rovamycin which causes intolerable back pain. The first month of 2nd trimester(4th month of preg) was relatively better.The 5th month I noticed that my immunity was very low and even subclinical infections causes me arthritis attacks . I also started to feel a little intoxicated then I knew that is because the baby now excretes its waste through my kidney , drinking a major amount of water is really helpful.
That’s it so far, I’ll try to keep You updated ,wish me luck.Hi Diddy,
I’ve emailed Dr.S but he has not answered . I wanted to ask him about the safest antibiotics I can take during pregnancy as I wanted to benefit from PetRescue experience with AP and its regimen during pregnancy . I hope You can provide this information for me as I can’t reach him.
This is awful that you have had to deal with toxoplasmosis when pregnant and to compound this that your AP remission from PsA has been compromised. Just wondering, but have you checked your thyroid levels? Rheumatic and thyroid disease can overlap and, as you likely know, a healthy thyroid during pregnancy will adjust to the demands of the fetus, but not necessarily if compromised by ill health. Thyroid imbalances can mimic rheumatic joint, tendon and muscle pain, so it might be worth checking this throughout your preganancy.
The National Health Service website outlines antibiotics that are safe to take during pregnancy for the baby. Azithromycin (treats mycoplasma) is one that many people will add to their tetracycline (but no tetras when pregnant), so maybe this abx will help both your PsA and the toxoplasmosis, because I believe it also has anti-protozoan effects. Just to be sure, you might want to check with your ob/gyne, though, as the other antibiotics mentioned in the following link may also provide better protection for your baby.
http://www.nhs.uk/Conditions/Toxoplasmosis/Pages/Treatment.aspx
As it meantions in the article, people with compromised immunity (presumably anyone with autoimmunity fits this category) is at risk of reactivation of latent toxoplasmosis, which would be similar to malaria. So, it would make sense to treat continuously throughout a pregsnacy to protect mother and baby. Rheumatic relapse can occur after partuition, when the high levels of pregnancy hormones crash, so if it was me, I wouldn’t take the risk of stopping AP during pregnancy, allowing whatever bug to build up momentum during the natural immune suppression of pregnancy…but that is just me. 😉
Very sorry to hear that Dr. S. hasn’t been able to reply to your email. I’d heard similar from others so it may be that he is now cutting back even further as he nears retirement? Very few docs are as generous with his time as he has been to rheumatic patients over the years, so this wonderful country doc has certainly earned his angel wings! Wish we could help more with insight for you, but we are just patients here, so can only share links to info on credible websites.
What is the recommendation during pregnancy for antibiotic use in your country?
Diddy, I do know of a very kind Lyme Literate MD in Texas who is an ob/gyne and should be able to answer your questions. I will PM you his contact info in case you want to try to connect with him.
Hi,
Of the antibiotics commonly used to treat rheumatic diseases, these are considered safe to use during pregnancy: azithromycin, erythromycin, and roxithromycin.
Note: I am not a medical doctor. The above information is the result of spending several hours examining the relevant scientific research that has been published in medical journals.
Phil
"Unthinking respect for authority is the greatest enemy of truth."
- Albert EinsteinThank you Maz and PhilC for the reply , I’ve good news about the toxoplasma , my PCR test came out negative and upon repetition of the IgM and IgG in a different lab they came out negative too , and the problem was in the kits used in the old lab , I’m now relieved to know that and the baby is growing just fine, thank god .
to answer your question about my thyroid function , yes I’m thyroid compromised as I found out that I’ve antithyroid antibodies a couple of years ago but didn’t take medication for it as my case was still subclinical . Thyroid function test was done for me immediately when I found out about my pregnancy and I’m taking 25 mg eltroxin daily as a booster for my metabolism during pregnancy .It is true that low thyroxin levels cause generalized muscle and joint pain , weakness and fatigue , I saw this happening to my father and we thought that he had RA just like me but he turned out to have autoimmune thyroid dis which caused low thyroid level.
About the azithromycin ,yes it’s known to be safe during pregnancy but it’s also very weak antibiotic and resistance to it occur rapidly , it’s good for treating acute infections in children like acute otitis media and mild bacterial skin and upper respiratory tract infections , but it’s a failure with chronic infections, even in chronic acne conditions the new studies state that it should not be used due to high resistance rate.
Erythromicin is a good antibiotic but has high resistance too, it’s mostly used in pregnancy in cases with premature rupture of membranes so I’d like to keep it an option for the late pregnancy.I was looking for someone who has experience with oral clindamycin during pregnancy as there is debate about its safety in pregnancy.
If you can provide the email of the doctor in texas ,I may be able to discuss that with him .
Thank you again ,
best wishesHi Diddy,
Fantastic to hear you feel confident that the toxoplasmosis has been well controlled! Hope you have now received my PM with the details of the LLMD ob/gyne in TX. Unfortunately, I was unable to locate his email, but if you put in a call to his office, this might produce results. If you have trouble calling and getting through, let me know in a PM.
Re: azithromycin, I think the question of resistance is why a combination antibiotic approach is generally preferred E.g. in the chlamydia pneumoniae, Lyme or even malaria treatment combination approaches. Also, as you already know, the treatment of toxoplasmosis, the standard is to use the combined antibiotic, Trimethoprim/sulfamethoxazole. The following scientific discussion recommends the combination approach to prevent resistant microbes, but also to sidestep the costly process of having to design and study new antimicrobials, a costly business.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3594660/#!po=1.56250
Also great to hear you (and your Dad) are well sorted with thyroid balance. Not having a thyroid (thyroidectomy 1.5 years ago due to toxic goiter), it astonished me just how much the thyroid affects pain levels in rheumatic disease and that “within normal range” means something entirely different for rheumatics where inflammation, low ferritin, and low Vit D3 may abrogate T4 to T3 conversion. Reverse T3 and RT3/FT3 ratio can be enlightening in this context. It’s caused me to be a strong believer in ensuring thyroid balance is in that “sweet spot” for anyone on AP, as this can impede and confuse progress. Also have to wonder how many people wind up thinking they have arthritis or fibromyalgia when really their thyroid is out of whack.
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