Page 96 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

Chapter 6
Table 3 - Cox regression for time to pregnancy counting from the moment of AMH measurement in women with rheumatoid arthritis who are trying to conceive (n=205)
Variable
log(AMH)
Age - per year
Never been pregnant before Disease duration - per year RF positivity
ACPA positivity
DAS28-CRP - per point Presence of erosions NSAIDs preconceptional Prednisone preconceptional Sulfasalazine
Past use of MTX
Hazard Ratio
1.09 0.96 0.43 0.99 0.73 1.12 0.85 1.57 0.57 0.77 0.89 1.12
95% con dence interval
p-value
0.94 ‒ 0.91 ‒ 0.30 ‒ 0.96 ‒ 0.47 ‒ 0.71 ‒ 0.73 ‒ 0.87 ‒ 0.40 ‒ 0.54 ‒ 0.64 ‒ 0.77 ‒
1.27 0.26 1.00 0.052 0.62 <0.001 1.02 0.50 1.15 0.17 1.76 0.62 0.98 0.026 2.85 0.13 0.81 0.002 1.10 0.16 1.26 0.52 1.62 0.55
AMH = anti-Müllerian hormone (in ug/L), RF = rheumatoid factor, ACPA = anti-citrullinated protein antibodies, DAS28- CRP = disease activity score with a 28 joint count and C-reactive protein, NSAIDs = non-steroidal anti-inflammatory drugs, MTX = methotrexate
The lower AMH levels in RA patients con rm recent ndings in a small study on AMH levels in RA, where 33 RA patients had lower AMH levels than age-matched controls.8 On the other hand, at the time of RA diagnosis, AMH levels have been found not to be signi cantly different from controls.32 Apparently, during the course of the disease, RA has a negative effect on the AMH levels. This is in line with studies on other chronic conditions reporting reduced AMH levels in women with cystic fybrosis,33 girls with newly diagnosed cancer,34 and women with Crohn’s disease35 or systemic lupus erythematosus.36 Also in women with type 2 diabetes mellitus a reduced ovarian reserve has been reported, as reflected by elevated FSH levels and reduced antral follicle counts compared to controls.37 Overall, these ndings support the hypothesis that the ovarian function is affected by a woman’s overall health status. Apparently, a woman’s capacity to reproduce is compromised in times when the soma is less healthy. In women with RA, this is also reflected in the younger age at which they appear to reach menopause, as has been reported in a previous case-control studies.4,5 Lower AMH levels, and the subsequently higher chance for early menopause may not only have implications for a woman’s fertility, but also for her overall long term health, since women who reach menopause at a younger age have an ongoing unfavorable health state, with increased lifetime risk for conditions such as osteoporosis, and cardiovascular disease.6
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