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Original research
Decline of ovarian function in patients with rheumatoid arthritis: serum anti-Müllerian hormone levels in a longitudinal cohort
  1. Jenny Brouwer1,2,
  2. Radboud J E M Dolhain1,
  3. Johanna M W Hazes1,
  4. Nicole S Erler3,
  5. Jenny A Visser4 and
  6. Joop S E Laven2
  1. 1Rheumatology, Erasmus MC, Rotterdam, Netherlands
  2. 2Obstetrics and Gynaecology - Division of Reproductive Medicine, Erasmus MC, Rotterdam, Netherlands
  3. 3Biostatistics, Erasmus MC, Rotterdam, Netherlands
  4. 4Internal Medicine, Erasmus MC, Rotterdam, Netherlands
  1. Correspondence to Radboud J E M Dolhain; r.dolhain{at}


Objective Rheumatoid arthritis (RA) often affects women in their fertile age, and is known to compromise female fertility. Serum anti-Müllerian hormone (AMH) levels are a proxy for the total number of primordial follicles, and a reliable predictor of the age at menopause. Our objective was to study the longitudinal intra-individual decline of serum AMH levels in female RA patients.

Methods Female RA patients from a nationwide prospective cohort (2002–2008) were re-assessed in 2015–2016. Serum AMH levels were measured using the picoAMH assay and compared with healthy controls. A linear mixed model (LMM) was built to assess the effect of RA-related clinical factors on the decline of AMH levels.

Results A group of 128 women were re-assessed at an age of 42.6±4.4 years, with a median disease duration of 15.8 (IQR 12.7–21.5) years. The time between first and last AMH assessments was 10.7±1.8 (range 6.4–13.7) years. Participants represented a more fertile selection of the original cohort. At follow-up, 39% of patients had AMH levels below the 10th percentile of controls (95% CI 31% to 48%), compared with 16% (95% CI 9.3% to 22%) at baseline. The LMM showed a significant decline of AMH with increasing age, but no significant effect of RA-related factors on AMH.

Conclusion AMH levels in RA patients showed a more pronounced decline over time than expected, supporting the idea that in chronic inflammatory conditions, reproductive function is compromised, resulting in a faster decline of ovarian function over time and probably an earlier age at menopause.

  • Arthritis
  • Rheumatoid
  • Epidemiology
  • Outcome Assessment
  • Health Care

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  • Contributors All authors contributed to the design of the study, the analysis and interpretation of the data. JB, RJEMD, JMWH, JAV and JSEL contributed to the acquisition of data. All authors contributed to the drafting and critically revising of the work. All authors approved the final version published.

  • Funding This study was funded by the Dutch Arthritis Foundation (ReumaNederland). The picoAMH assays were generously provided by Ansh Labs (Houston, Texas, USA).

  • Competing interests JB, JMWH and JAV declare no conflicts of interests. RJEMD has received an unrestricted research grant from UCB Pharma BV. JSEL has received unrestricted research grants from the following companies (in alphabetical order) Ferring, Merck Sharpe and Dome, Merck Serono, Organon, Shering Plough and Serono.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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