Background/Purpose: Patients with rheumatoid arthritis (RA) display a higher infertility prevalence compared with the general population. Disease-related inflammation and RA treatments are likely to be the main factors explaining the RA patients’ infertility. Nevertheless, the tangible link between these different factors and the decline in  women’s fertility has never been clearly demonstrated. This study sought to examine the impact of RA disease activity and treatments on ovarian reserve measured by serum AMH levels in a large patient cohort over 36 months. Using this analysis, we sought to better define the indications for fertility preservation in RA patients.

Methods: Patient and serum analysis data were derived from the French national prospective cohort ESPOIR (Etude et Suivi des POlyarthrites Indifférenciées Récentes). Enrolled patients (n= 117; 18-37-year-olds) fulfilling ACR/EULAR2010 criteria for RA were not receiving any medication at enrolment time (T0). Patients were examined and serum AMHs level measured at T0, 6(T6), 12(T12), 24(T24), and 36(T36) months post-diagnosis.

Serum AMH measurements were performed using the electrochemiluminescence method (analyser Cobas® e411). The impact of both RA activity (evaluated by DAS28 scores and CRP levels) and treatments (methotrexate and corticosteroids) was evaluated at each study visit.

Results: Overall, 117 women from the ESPOIR cohort, aged 18-37 years, were included. The mean age was 29.2+/-5.3 years, mean body mass index 22.96 (+/-3.57)Kg/m², mean DAS 28 4.95 (+/-1.24) (range: 1.57-8.30), thus reflecting moderate RA activity, and mean CRP 22.5+/-34mg/L.

A gradual decrease in patients’ serum AMH levels was observed over time, in line with the descending curve described in the literature for healthy women (Kelsey et al.,2011). Serum AMH levels of RA patients in comparison with the values considered normal for age did not reveal any significant differences at T6, T12, T24, and T36 (p >0.05). We did not observe any impact of RA treatments on serum AMH levels, irrespective of the medication administered, and even after adjusting for age and DAS 28 score (p=0.81). We demonstrated an inverse correlation between serum AMH level variations and inflammation parameters (DAS28: r=-0.27, p=0.003; CRP: r=-0.16, p=0.06).

Conclusion: This is the first study to determine serum AMH levels of a large cohort of young RA patients over 36 months. A quick disease activity limitation appears required to limit ovarian reserve alterations. Oocytes or ovarian tissues are not likely to be necessary if inflammation is promptly controlled. No impact of RA treatments was observed. More studies are required to further explain the pathophysiological mechanisms underlying these associations.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/fertility-of-women-with-rheumatoid-arthritis-disease-activity-negatively-correlates-with-serum-amh-levels/