To read the full abstract: Mod Rheumatol. 2019 May; 29 (3):447
In recent years, attention has been increasing on the ovarian reserve in juvenile rheumatic diseases (14). Premature ovarian failure is described in 3.57.5% of juvenile idiopathic arthritis (JIA) patients, mainly in older subjects (mean age 35 years) and in patients treated with chlorambucil for amyloidosis (56). This cross-sectional study analyzed ovarian function during the early follicular phase in 28 post-pubertal JIA patients (mean age 22.6 years) and 28 healthy age-matched controls. A higher median menarche age, a lower median AMH levels with higher LH and estradiol levels were observed in JIA patients, without any correlation with current age, disease duration, number of active/limited joints, inflammation markers, cumulative glucocorticoid and methotrexate doses. These results suggest a precocious impairment of ovarian reserve, not associated with hypothalamic pituitary gonadal axis dysfunction. This impairment appears to be related to disease activity, rather than to its treatment, and an early and progressive ovarian damage due to autoimmune mechanisms is hypothesized.
This chronic inflammatory disease occurs mainly in females during their early reproductive age, making the issue of ovarian reserve and future fertility particularly relevant and probably still underestimated. A strength of this study is the rigorous selection criteria of JIA patients and controls (<40 years, without gynecologic diseases and hypothalamic-pituitary-ovary axis dysfunction), however the small sample size is a limitation. The confirmation of impaired ovarian reserve and its impact in future fertility in JIA patients is an important aspect to be evaluated in larger, prospective studies.
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