Page 20 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

Chapter 1
Menopause in RA
Compared to healthy control women, menopause occurs slightly earlier in women with RA.69,70 Even in women with postmenopausal onset of the disease, the mean age at menopause was signi cantly lower compared to matched controls.69 However, not all studies have con rmed the younger age at menopause.75
Studying reproduction in RA – the PARA cohort
This thesis focuses mainly on patients from the Pregnancy-induced Amelioration of Rheumatoid Arthritis (PARA) study. The PARA study aimed to study the changes in the disease course of RA during pregnancy and the postpartum period.22 The PARA cohort was a nationwide observational prospective cohort, for which eligible patients from the Netherlands were recruited by their attending rheumatologists from May 2002 until November 2008. Patients were eligible when they had a diagnosis of RA according to the 1987 revised ACR criteria9 and were trying to conceive or were already pregnant. Patients had to have a good understanding of the Dutch language. During the study, patients received usual medical care from their attending rheumatologist. Teratogenic medications, such as MTX, had to be stopped at least 3 months before trying to conceive.
Members of the PARA research team visited the patients at their homes during the preconception period (if possible), once during each trimester of pregnancy, and at six, twelve and 26 weeks postpartum. At each visit, questionnaires on health, medication use, and obstetric information were lled out. Blood and urine samples were collected at each assessment, and the RA disease activity was measured using a standardized swollen and tender joint count for 28 joints, which was combined with the serum C-reactive protein (CRP) levels (DAS28-CRP).13
During the years of observation within the PARA cohort, it appeared that many patients had problems achieving a pregnancy. It often took patients longer to conceive, and a considerable number of patients needed arti cial reproductive treatments to achieve pregnancy.23
18