Page 13 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

Rheumatoid arthritis is a common disease which seems to be interlinked with 1 impaired fertility. How exactly this disease might affect fertility is largely unknown.
This introduction will provide an overview of the possible interaction between
rheumatoid arthritis and fertility. Before doing so we will provide some basic understanding of rheumatoid arthritis in general. Next, a description is given of
ovarian function and its regulators. Furthermore, the available literature on fertility in rheumatoid arthritis will be summarized. The latter will be followed by a description of the design of the PARA study, which has been the fundament for the main part of this thesis. Finally, the objectives of this thesis will be described as well as its outline.
Rheumatoid arthritis
Rheumatoid arthritis (RA) is a chronic systemic inflammatory auto-immune disease. With a prevalence of 0.5 – 1.0 % of adults in Western countries, it is one of the most common auto-immune rheumatic diseases.1 Typically, RA occurs more often in females than in males.2,3 The incidence of RA increases with age.4 Over all ages, and especially in adults younger than 45 years, more women than men are affected.2 Over time, RA can lead to permanent joint damage5, but extra-articular manifestations are also common.4 In patients with RA, mortality rates are increased, amongst others through an increased risk from cardiovascular, infectious, hematologic, gastrointestinal , and respiratory comorbidities and complications.6
Serology
Autoantibodies are often present in RA. The presence of rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPAs) can precede a clinical diagnosis of RA by years.7,8 RF was the rst known antibody associated with RA, and has been part of past and future classi cation criteria for RA.5,9,10 ACPAs have been discovered more recently, and their presence is highly speci c for the development of RA.10 Furthermore, ACPAs are more discriminative than RF in distinguishing RA from other arthritic diseases.11 Moreover, ACPA positive patients appear to have a different form of RA than ACPA negative patients, with ACPA positive patients having a higher chance of radiological joint damage, more extra-articular manifestations, and a different response to anti- rheumatic therapy, often requiring a more intensive treatment strategy.10
Diagnosis
For decades, patients were diagnosed with RA when the disease had already reached a destructive state and had caused permanent joint damage. For study purposes,
General introduction
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