Page 80 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

Chapter 5
in AMH levels did not differ between the two groups (p=0.422) ( gure 2), and was not dependent on age, DAS28, presence of RF or anti-CPP, and MTX use. AMH levels did not differ signi cantly either between patients using MTX and controls (p=0.394) or between patients without MTX and controls (p=0.657) ( gure 1B).
Figure 2. The individual change in serum anti-Müllerian hormone (AMH) levels from time of diagnosis (T0) to six months later (T6) in (A) rheumatoid arthritis (RA) patients not using methotrexate (MTX) and (B) RA patients who are using MTX during the six months following diagnosis. The proportional change in time of AMH levels between the two groups shows no signi cant difference (p=0.422).
DISCUSSION
To our knowledge, this is the rst study reporting on AMH serum levels in RA patients. Our results show that serum AMH concentrations in women with early RA are comparable to healthy controls. Serum AMH levels in early RA are neither influenced by parameters of disease activity nor by use of MTX. This study hereby provides an answer to Clowse et al., who suggest AMH as a marker to detect subclinical damage to the ovary during and after cyclophosphamide therapy, but point out that the impact of rheumatologic disease and anti-rheumatic drugs on AMH expression is unknown.9 Subfertility might already be present in RA patients at time of diagnosis.1 However, according to current results, this appears not to be due to a reduced ovarian reserve. As earlier menopause has especially been reported in RF positive RA patients,1 auto-
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