Page 104 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

Chapter 7
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ABSTRACT
Background: In several chronic conditions an early decline of ovarian function is found. Whether the same holds true for chronic inflammation, such as rheumatoid arthritis (RA) is unknown. RA is known to compromise female fertility, and often affects women in their fertile age. Serum anti-Müllerian hormone (AMH) levels are a proxy for the total number of primordial follicles, and a reliable predictor of the age at menopause. Our objective was to study the longitudinal intra-individual decline of serum AMH levels in female RA patients.
Methods: Female RA patients from a nationwide prospective cohort (PARA study, 2002-2008), were re-assessed in 2015-2016. Serum AMH levels were measured using the picoAMH assay and compared to healthy controls. A linear mixed model (LMM) was built to assess the effect of RA-related clinical factors on the decline of serum AMH levels.
Results: One hundred and twenty-eight women were re-assessed at an age of 42.6 ± 4.4 years, with a median disease duration of 15.8 (IQR 12.7 – 21.5) years. The time between the rst and last AMH assessments was 10.7 ± 1.8 (range 6.4 – 13.7) years. Participants represented a more fertile selection of the original PARA cohort. At follow-up, 39% of patients had AMH levels below the 10th percentile of controls (95%CI 31 – 48%), compared to baseline levels (16%; 95%CI 9.3 – 22%). The LMM showed a signi cant decline of AMH levels with increasing age, but no signi cant effect of RA-related factors on AMH.
Conclusion: AMH levels in RA patients showed a more pronounced decline over time than expected, supporting the idea that also in chronic inflammatory conditions, reproductive function is compromised, resulting in a faster decline of ovarian function over time and probably an earlier age at menopause.