Page 132 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

The ovarian function in early RA is evaluated in chapter 5. Serum AMH levels in women within the Rotterdam Early Arthritis Cohort who had recently been diagnosed with RA were not different from AMH levels in healthy controls. There was no association of AMH levels with RA serology, the presence of erosions, or disease activity. Furthermore, six months of methotrexate therapy did not result in a faster decline of serum AMH levels.
Chapter 6 returns to the PARA cohort, studying the ovarian function in the preconception period and its relation with time to pregnancy. In this group of women with a median disease duration of RA of 4.5 years, serum AMH levels were signi cantly lower than in healthy controls, with 17% of patients below the age- speci c 10th percentile of healthy controls. Serum AMH levels were lower in ACPA positive patients. Time to pregnancy was not associated with AMH levels.
The decline of ovarian function in RA over a longer period is studied in chapter 7. For this purpose a follow-up study of the women participating in the PARA-cohort was undertaken, with last serum samples being taken at a median disease duration of 15.8 years. Over the years, serum AMH levels in women with RA showed a steeper decline than healthy controls with 39% of women having serum AMH levels below the 10th percentile of healthy controls at the last observation.
Finally, in the general discussion in chapter 8 clinical implications for both rheumatologists and gynaecologists are described, and suggestions for future research are given. The importance of individualized medicine in women with rheumatoid arthritis is discussed.
130