TTP in RA is longer if patients are older or nulliparous, have higher disease activity, use NSAIDs or use prednisone >7.5 mg daily. Preconception treatment strategies should aim at maximum suppression of disease activity, taking account of possible negative effects of NSAIDs use and higher prednisone doses.
Objective. Fertility is reduced in women with rheumatoid arthritis (RA), even before diagnosis. This may be due to a diminished ovarian reserve. The current study examined serum levels of anti-Mü llerian hormone (AMH), the most reliable endocrine marker for ovarian reserve, in early RA patients and the influence of disease activity and methotrexate (MTX) use on AMH concentrations. Methods. Serum AMH levels were measured in 72 women with recent-onset RA ages 18 -42 years and compared to 509 healthy women. The association between AMH and rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), erosions, C-reactive protein (CRP) level, disease activity (Disease Activity Score in 28 joints [DAS28]), and use of MTX was assessed. Results. At diagnosis, age-adjusted serum AMH levels did not differ significantly between patients and controls (P ؍ 0.254). AMH levels were not related to the presence of RF (P ؍ 0.487), anti-CCP (P ؍ 0.686), or erosions (P ؍ 0.350), and showed no significant correlation with CRP levels (r ؍ ؊0.207, P ؍ 0.083) or disease activity scores (DAS28; r ؍ 0.007, P ؍ 0.955). After 6 months of treatment, AMH levels in patients (n ؍ 53) were lower than at the time of diagnosis (P < 0.001), but did not differ from controls (P ؍ 0.741). There was no significant difference in AMH values after 6 months of treatment between patients who did (n ؍ 31) or did not (n ؍ 22) receive MTX (P ؍ 0.287). Conclusion. AMH levels in women with early RA are comparable to those of healthy controls, indicating that the reduced fertility in this patient group is not caused by diminished ovarian reserve. AMH levels are not affected either by disease activity or by short-term MTX use.
ObjectiveSubfertility is frequently encountered among female rheumatoid arthritis (RA) patients and has been associated with disease activity and antirheumatic drugs. However, little is known about the results of the fertility assessments in these women. Our aim was to study the outcome of fertility assessments in subfertile women with RA.MethodsA cross‐sectional study was performed in a nationwide cohort of female RA patients who were pregnant or trying to conceive between 2002 and 2010 (Pregnancy‐Induced Amelioration of Rheumatoid Arthritis Study). Patients who had given consent for future contact (n = 260) received a questionnaire on reproductive history, fertility examinations, and fertility treatments. Medical files were obtained from attending gynecologists.ResultsA completed questionnaire was returned by 178 women (68%), of whom 96% had ended their efforts to conceive. Eighty‐two subjects (46%) had at least 1 subfertile episode, and for 61 women a diagnosis for subfertility was available. Unexplained subfertility (48%) and anovulation (28%) were the most common gynecologic diagnoses, and both occurred more often in RA patients than reported in the general population. Women with unexplained subfertility more often used nonsteroidal antiinflammatory drugs (NSAIDs) during the periconceptional period. Seventeen percent of all pregnancies were conceived after fertility treatments. Fertility treatments had equal or higher pregnancy rates in RA compared to other subfertile populations.ConclusionUnexplained subfertility is more often diagnosed in subfertile female RA patients than in the general population, and is related to periconceptional NSAID use. Despite the higher incidence of subfertility in women with RA, the outcome of fertility treatments in these women appears favorable.
Objective. To study the association between miscarriage in rheumatoid arthritis (RA) patients and serologic findings, disease activity, and antirheumatic drug treatment, and to study disease activity and reproductive outcomes after a miscarriage.Methods. Within a nationwide prospective cohort study (Pregnancy-Induced Amelioration of RA study), patients with RA were followed up from preconception until 6 months after delivery or miscarriage. Univariate and logistic regression analyses were performed to assess variables of interest, with covariates included in the models if the P value for association with miscarriage was <0.20 and subsequently excluded if the P value was >0.10.Results. Among 162 pregnancies, 28 miscarriages occurred (17.3%; 95% confidence interval 12.2-24.0%). Women who miscarried were older than women with an ongoing pregnancy. Women who miscarried tended to be more often positive for anti-citrullinated protein antibodies (ACPAs), to have higher disease activity scores, and to have more often received methotrexate (MTX) therapy in the past. Logistic regression showed a tendency toward a higher likelihood of miscarriage in association with increasing age (P 5 0.065) and presence of ACPAs (P 5 0.092). After miscarriage, 33% of women had a flare of RA. Within 1 year, 68% of women became pregnant again, 14% stopped trying to conceive, and 11% were lost to followup. The live birth rate of the subsequent pregnancy was 90%.Conclusion. The miscarriage rate in the PARA cohort is comparable to that in the general population. Due to the low frequency of miscarriages in this study, the associations between miscarriage in RA and the presence of ACPAs, disease activity, and MTX use did not reach statistical significance. Within 1 year after miscarriage, the majority of patients who continued trying to conceive achieved a pregnancy resulting in a live birth.
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