Page 99 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

Concerning disease characteristics, our study cohort appears to be representative for patients with established RA. However, we have to consider the changes in management of RA since the end of the PARA study follow-up in 2010. Nowadays, anti-rheumatic treatment is based on treat-to-target guidelines. Moreover, so-called biologicals (such as tumor necrosis factor alpha blockers) are prescribed more often and also earlier in the disease course. Since several biologicals appear to be safe during pregnancy,43 they are also prescribed more often in women trying to conceive. Therefore, the current preconceptional patients will differ from the patients in the PARA cohort regarding disease activity and the use of anti-rheumatic drugs. New observational cohorts will have to address whether these changes in treatment have a positive effect on ovarian reserve, fertility and offspring in RA patients.
In conclusion, serum AMH levels are decreased in women with RA, and lower AMH levels show an association with ACPA positive disease, which is often related to a more severe disease state. However, preconceptional AMH levels are not associated with TTP in RA, and therefore cannot explain the reduced fertility in these patients. Since decreased AMH levels may result in an early occurrence of menopause, further study in RA patients should clarify the long-term effect of RA and anti-rheumatic drugs on the age at which menopause occurs.
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AMH in RA – time to pregnancy
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