Page 106 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

Chapter 7
Rheumatoid arthritis (RA) is an example of a chronic inflammatory auto-immune disease that often affects women in their fertile age. RA not only affects the joints, but can also cause extra-articular damage, affecting different organ systems.11,12 A prolonged time to pregnancy13,14 and a younger age at which menopause sets in15,16 are both indicators that in women with RA the ovarian function may be compromised as well.
In women with RA, AMH levels at time of diagnosis have been found to be comparable to those in healthy controls.17 Furthermore, after 6 months of methotrexate (MTX) therapy in RA patients, AMH levels did not differ from those in patients who did not use MTX.17 When analysing women with established RA, AMH levels were indeed lower compared to healthy controls.18,19 However, thus far there have been no longitudinal studies on AMH levels in RA patients. Nor has the effect of disease characteristics on the decline of AMH levels over time been studied.
The objective of the current study was to investigate the intra-individual change in AMH levels over a longer time period in women with RA. We compared serum AMH levels in RA patients with those in controls from the general population, and studied the decline of serum AMH levels in RA patients over time in relation to RA-related clinical factors.
METHODS
Patients
For this observational cohort study, patients were recruited who had participated in the Pregnancy-induced amelioration of RA (PARA) study. The PARA study was a nationwide prospective cohort study, which was performed in the Netherlands in 2002-2010.20 Patients were invited to participate by their attending rheumatologist if they had a diagnosis of RA according to the 1987 ACR criteria,21 and if they were actively trying to conceive or were already pregnant. Patients had to have a good understanding of the Dutch language.20 Patients could participate in the PARA study more than once. For the current follow-up study, patients were contacted when they had given consent to be contacted for future research, and when they had at least 1 non-pregnant serum sample available (i.e. from a preconception visit, or from a visit 6 months postpartum).
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