Department of Pediatric Endocrinology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Department of Pediatric Rheumatology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Clin Rheumatol. 2024 Jan;43(1):399-406. doi: 10.1007/s10067-023-06747-w. Epub 2023 Aug 30.
BACKGROUND/OBJECTIVES: The aim of the study is to assess the effect of juvenile idiopathic arthritis (JIA) and biologic disease-modifying anti-rheumatic drugs (bDMARDs) on ovarian reserve in children.
A cross-sectional study was performed from March 2021 to March 2022 and included 81 patients with JIA and 49 healthy children. Serum anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol levels were analyzed using electrochemiluminescence methods.
The mean of current age (13.5 ± 3.2 vs. 14.4 ± 2.4 years), height standard deviation score (SDS) (- 0.35 ± 1.18 vs. - 0.44 ± 0.94), body mass index SDS (0.12 ± 1.33 vs. 0.25 ± 1.28), and the median weight SDS (- 0.13 (- 2.27-3.23) vs. - 0.52 (- 3.4-3.3)) were similar in JIA patients and controls (p > 0.05). Patients with JIA were divided into two groups according to their treatment regimens: treated with methotrexate (MTX) (biologic naive) (n = 32) and treated with MTX plus bDMARDs (n = 49). No significant differences were detected between the 3 groups regarding menarche age, menstrual cycle length, and flow duration (for all p > 0.05). The median serum concentration of AMH was 2.94 (1.12-7.88) ng/ml in the control group, 3.02 (0.36-8.54) ng/ml in the biologic naïve group, and 3.01 (0.99-8.26) ng/ml in the MTX plus bDMARD group. There were no significant differences between 3 groups according to serum AMH, FSH, LH, and estradiol levels (p > 0.05).
Biologic DMARDs are reassuring in terms of ovarian reserve in girls with JIA and demonstrate that AMH is unaffected by treatment. Prospective studies with larger sample sizes are needed to confirm our findings and to evaluate the impact on the future fertility of patients. Key Points • Although biologic disease-modifying anti-rheumatic drugs (bDMARDs) are being game-changing treatment options in juvenile idiopathic arthritis, their effect on fertility and ovarian reserve is one of the most discussed issues. • In addition to treatment used, autoimmune diseases might also have a negative effect on fertility. • In this cross-sectional study, we found that anti-Mullerian hormone level of patients who were on bDMARDs, patients who were on methotrexate, and healthy controls were similar. • Our results suggest that bDMARDs are reassuring in terms of ovarian reserve in girls with JIA and demonstrate that AMH is unaffected by treatment.
背景/目的：本研究旨在评估幼年特发性关节炎（JIA）和生物改善病情抗风湿药（bDMARDs）对儿童卵巢储备功能的影响。
一项横断面研究于 2021 年 3 月至 2022 年 3 月进行，纳入了 81 例 JIA 患儿和 49 例健康儿童。采用电化学发光法分析血清抗苗勒管激素（AMH）、卵泡刺激素（FSH）、黄体生成素（LH）和雌二醇水平。
JIA 患儿的平均当前年龄（13.5±3.2 岁对 14.4±2.4 岁）、身高标准差评分（-0.35±1.18 对-0.44±0.94）、体重指数标准差评分（0.12±1.33 对 0.25±1.28）和中位数体重标准差评分（-0.13[-2.27-3.23]对-0.52[-3.4-3.3]）与对照组相似（p＞0.05）。根据治疗方案，JIA 患儿分为两组：接受甲氨蝶呤（MTX）（生物初治）（n=32）和接受 MTX 加 bDMARDs（n=49）。3 组间的初潮年龄、月经周期长度和经期持续时间无显著差异（均 p＞0.05）。对照组 AMH 血清浓度中位数为 2.94（1.12-7.88）ng/ml，生物初治组为 3.02（0.36-8.54）ng/ml，MTX 加 bDMARD 组为 3.01（0.99-8.26）ng/ml。3 组间 AMH、FSH、LH 和雌二醇血清水平无显著差异（p＞0.05）。
生物 DMARDs 对 JIA 女孩的卵巢储备功能是安全的，且表明 AMH 不受治疗影响。需要更大样本量的前瞻性研究来证实我们的发现，并评估其对患者未来生育能力的影响。关键点：
尽管生物改善病情抗风湿药（bDMARDs）是幼年特发性关节炎治疗的变革性选择，但它们对生育能力和卵巢储备的影响是最受关注的问题之一。
除了治疗方法外，自身免疫性疾病也可能对生育能力产生负面影响。
在这项横断面研究中，我们发现接受 bDMARDs 治疗、接受甲氨蝶呤治疗和健康对照组患者的抗苗勒管激素水平相似。
我们的研究结果表明，生物 DMARDs 对 JIA 女孩的卵巢储备功能是安全的，且表明 AMH 不受治疗影响。
