Page 131 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

Rheumatoid arthritis (RA) is one of the most common rheumatic diseases. Impaired fertility in women with RA has been reported, but little is known about the exact mechanisms behind subfertility in this patient group. The aims of this thesis were (I) to assess the time to pregnancy in a cohort of women with RA who wished to conceive, and to determine its association with clinical aspects of RA, (II) to study the occurrence of miscarriages in RA, and (III) to research the ovarian function in RA, both during the preconception period, as well as (IV) during a longer time period.
The introduction in chapter 1 gives a general overview of RA, its diagnosis and treatment. Furthermore, a description of ovarian function, and the use of anti- Müllerian hormone (AMH) as a serum marker for this ovarian function is given. After a brief explanation on subfertility in the general population, an overview is given on what is known about fertility problems, miscarriages, and menopause in women with RA. Finally, the design of the Pregnancy Induced Amelioration of RA (PARA) study is described, since the studies in this thesis were performed mainly within the PARA cohort.
Chapter 2 describes the increased time to pregnancy (TTP) within the PARA cohort and its relation with several disease characteristics and anti-rheumatic treatment. A longer TTP was related to age, nulliparity, disease activity (DAS28), and preconception use of non-steroidal anti-inflammatory drugs (NSAIDs) and prednisone. The effect of prednisone was dose-dependent, with a longer TTP when higher dosages of prednisone were taken.
The outcomes of fertility assessments in RA patients are addressed in chapter 3. After fertility work-up, subfertile women with RA often received a diagnosis of unexplained subfertility, or of anovulation. Unexplained subfertility was related to periconception use of NSAIDs, suggesting that these drugs have a negative effect on fertility. A relative high percentage of pregnancies were the result of fertility treatments. Despite the higher incidence of subfertility in the study group, the outcome of fertility treatments appeared favorable.
In chapter 4, the association between miscarriages and RA related clinical factors S is studied. The miscarriage rate in the PARA cohort was comparable to that in the
general population. There was a possible association of the occurrence of miscarriages
with ACPA positive disease, but this was not statistically signi cant. The majority of
patients who had miscarried and continued trying to conceive, achieved an ongoing, successful pregnancy within one year after their miscarriage.
Summary
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