Impact of disease activity and treatments on ovarian reserve in patients with rheumatoid arthritis in the ESPOIR cohort

Camille Valdeyron (1) , Martin Soubrier (2) , Bruno Pereira (3) , Arnaud Constantin (4) , Jacques Morel (5, 6, 7) , Philippe Gaudin (8) , Bernard Combe (5, 6, 7) , Anne Sophie Gremeau (1) , Lydie Dejou-Bouillet (1) , Jean Luc Pouly (1) , Vincent Sapin (9) , Charlotte Oris (9) , Florence Brugnon (1, 10)

1 CHU Estaing [Clermont-Ferrand]
2 CHU Gabriel Montpied [Clermont-Ferrand]
3 DRCI - Direction de la recherche clinique et de l’innovation [CHU Clermont-Ferrand]
4 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
5 Département de Rhumatologie[Montpellier]
6 IGMM - Institut de Génétique Moléculaire de Montpellier
7 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
8 Hôpital Sud [Échirolles]
9 CHU Clermont-Ferrand
10 IMoST - Imagerie Moléculaire et Stratégies Théranostiques

Abstract Objectives Patients with RA have a higher prevalence of infertility than the general population. This study sought to examine the impact of RA disease activity and treatments on ovarian reserve measured by serum anti-Müllerian hormone (AMH) levels in the ESPOIR cohort. We sought to better define the indications for fertility preservation. Methods Patients and serum analysis data were derived from the French national cohort ESPOIR. Enrolled patients (n = 102; 18–37-year-olds) fulfilled ACR/EULAR 2010 criteria for RA. Serum AMH levels were measured at T0, T6, T12, T24 and T36 months post-diagnosis. The impacts of RA activity (DAS28 and CRP level) and treatments (MTX only or with other medications) were evaluated at each study visit. Results A gradual decrease in patients’ serum AMH levels was observed over time, in line with the descending curve described for healthy women. Serum AMH levels of RA patients in comparison with the values considered normal for age did not reveal any significant differences (P > 0.05). We did not observe any impact of RA treatments. We demonstrated an inverse correlation between AMH variation and disease activity (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 RA patients over 36 months. Rapid disease activity control appears to be required to limit changes in the ovarian reserve. Fertility preservation is not likely to be necessary if inflammation is promptly controlled. ClinicalTrials.gov Identifier NCT03666091.

Mots clés: AMH/DAS28, disease activity, fertility, inflammation, methotrexate, ovarian reserve, rheumatoid arthritis, woman

Domaines: Sciences du Vivant [q-bio]

Camille Valdeyron, Martin Soubrier, Bruno Pereira, Arnaud Constantin, Jacques Morel, et al.. Impact of disease activity and treatments on ovarian reserve in patients with rheumatoid arthritis in the ESPOIR cohort. Rheumatology, 2020, ⟨10.1093/rheumatology/keaa535⟩. ⟨hal-03040700⟩