Background/Purpose: Juvenile idiopathic arthritis (JIA) occurs during reproductive age and therefore ovarian reserve and future fertility are a relevant issue for this population. There is, however, no study performing a complete assessment of ovarian function in this chronic inflammatory disease.

Methods: One hundred and seven adolescent and young adult female patients with JIA (ILAR criteria) were selected for this study. Eight-four patients were excluded due to: hypothyroidism (n=6), current amenorrhea (n=4), current pregnancy/lactation (n=3), polycystic ovarian syndrome (n=2) and unwillingness to stop hormonal contraceptive or not agreeing to participate in this study (n=69). Therefore, 23 JIA patients and 23 healthy controls were studied. Complete ovarian function was assessed during the early follicular phase of the menstrual cycle (between the first and fifth day of menses) with estradiol, luteinizing hormone (LH), follicle stimulating hormone (FSH) – all three by radioimmunoassay, anti-Müllerian hormone (AMH) – by automated Access AMH immunoassay, Beckman Coulter, and antral follicle count (AFC) – by transvaginal or abdominal ultrasound. Demographic data, menstrual abnormalities, patient and physician visual analogue scales (VAS), number of active and limited joints, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and treatment were also evaluated.

Results: The median current age (22 vs. 23 years, p=0.834), menstrual flow duration (5 vs. 5 days, p=0.478) and cycle length (28 vs. 29 days, p=0.750) were similar in JIA patients and healthy controls. The median of AMH levels [2.66 (0.47-6.47) vs. 5.43 (0.98-17.24) ng/mL, p=0.010] were significantly reduced in JIA patients versuscontrols, whereas FSH [6.3 (4.7-12.2) vs. 5.7(2.6-9.8) IU/L, p=0.029], LH [7.7(2.4-13.2) vs. 4.9(1.1-14.4) IU/L, p=0.027] and estradiol levels [47.4 (25-8-160.2) vs. 35.1 (26.2-71.0) pg/mL, p=0.02] were significantly elevated in the latter group. AFC was comparable in JIA and controls (p>0.05). Further analysis of JIA patients revealed that current age, disease duration, number of active and limited joints, ESR, CRP, patient and physician VAS, cumulative glucocorticoid and cumulative methotrexate dose were not correlated with AMH, FSH, estradiol levels or AFC (p>0.05).

Conclusion: The present study was the first to identify a subclinical ovarian dysfunction in JIA patients during reproductive age, not correlated with disease activity or treatment factors. Future studies are necessary to determine the possible role of ovarian autoantibodies for this condition.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/reduced-ovarian-reserve-in-young-juvenile-idiopathic-arthritis-patients/