Rheumatology, Erasmus MC, Rotterdam, Netherlands.
Obstetrics and Gynaecology - Division of Reproductive Medicine, Erasmus MC, Rotterdam, Netherlands.
RMD Open. 2020 Oct;6(3). doi: 10.1136/rmdopen-2020-001307.
Rheumatoid arthritis (RA) often affects women in their fertile age, and is known to compromise female fertility. Serum anti-Müllerian hormone (AMH) levels are a proxy for the total number of primordial follicles, and a reliable predictor of the age at menopause. Our objective was to study the longitudinal intra-individual decline of serum AMH levels in female RA patients.
Female RA patients from a nationwide prospective cohort (2002-2008) were re-assessed in 2015-2016. Serum AMH levels were measured using the picoAMH assay and compared with healthy controls. A linear mixed model (LMM) was built to assess the effect of RA-related clinical factors on the decline of AMH levels.
A group of 128 women were re-assessed at an age of 42.6±4.4 years, with a median disease duration of 15.8 (IQR 12.7-21.5) years. The time between first and last AMH assessments was 10.7±1.8 (range 6.4-13.7) years. Participants represented a more fertile selection of the original cohort. At follow-up, 39% of patients had AMH levels below the 10th percentile of controls (95% CI 31% to 48%), compared with 16% (95% CI 9.3% to 22%) at baseline. The LMM showed a significant decline of AMH with increasing age, but no significant effect of RA-related factors on AMH.
AMH levels in RA patients showed a more pronounced decline over time than expected, supporting the idea that in chronic inflammatory conditions, reproductive function is compromised, resulting in a faster decline of ovarian function over time and probably an earlier age at menopause.
类风湿关节炎（RA）常发生于育龄期女性，已知其会损害女性生育能力。血清抗苗勒管激素（AMH）水平是原始卵泡总数的替代指标，也是绝经年龄的可靠预测指标。我们的目的是研究女性 RA 患者血清 AMH 水平的纵向个体内下降。
对来自全国性前瞻性队列（2002-2008 年）的女性 RA 患者于 2015-2016 年进行重新评估。使用 picoAMH 检测法测量血清 AMH 水平，并与健康对照组进行比较。采用线性混合模型（LMM）评估与 RA 相关的临床因素对 AMH 水平下降的影响。
一组 128 名女性在 42.6±4.4 岁时重新评估，中位疾病持续时间为 15.8（IQR 12.7-21.5）年。首次和末次 AMH 评估之间的时间为 10.7±1.8 年（范围 6.4-13.7）。参与者代表了原始队列中更具生育力的选择。在随访时，39%的患者 AMH 水平低于对照组第 10 百分位数（95%CI 31%至 48%），而基线时为 16%（95%CI 9.3%至 22%）。LMM 显示 AMH 随年龄增长而显著下降，但与 RA 相关因素对 AMH 无显著影响。
RA 患者的 AMH 水平随时间的推移呈更明显的下降，支持在慢性炎症情况下生殖功能受损的观点，导致卵巢功能随时间的快速下降，可能更早绝经。
