ESPE Yearbook of Paediatric Endocrinology

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 (1–4). Premature ovarian failure is described in 3.5–7.5% of juvenile idiopathic arthritis (JIA) patients, mainly in older subjects (mean age 35 years) and in patients treated with chlorambucil for amyloidosis (5–6). 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.

References: 1. De Araujo DB, Yamakami LY, Aikawa NE, Bonfá E, Viana VS, Pasoto SG, Pereira RM, Serafin PC, Borba EF, Silva CA. Ovarian reserve in adult patients with child- hood-onset lupus: a possible deleterious effect of methotrexate? Scand J Rheumatol. 2014; 43: 503–511.

2. Aikawa NE1, Sallum AM, Leal MM, Bonfá E, Pereira RM, Silva CA. Menstrual and hormonal alterations in juvenile dermatomyositis. Clin Exp Rheumatol. 2010; 28: 571–575.

3. Aikawa NE, Sallum AM, Pereira RM, Suzuki L, Viana VS, Bonfa E, et al. Subclinical impairment of ovarian reserve in juvenile systemic lupus erythematosus after cyclophosphamide therapy. Clin Exp Rheumatol. 2012; 30:445–449.

4. Henes M, Froeschlin J, Taran FA, Brucker S, Rall KK, Xenitidis T, Igney-Oertel A, Lawrenz B, Henes JC. Ovarian reserve alterations in premenopausal women with chronic inflammatory rheumatic diseases: impact of rheumatoid arthritis, Behçet’s disease and spondyloarthritis on anti-Müllerian hormone levels. Rheumatology (Oxford) 2015; 54: 1709–1712.

5. David J, Vouyiouka O, Ansell BM, Hall A, Woo P. Amyloidosis in juvenile chronic arthritis: a morbidity and mortality study. Clin Exp Rheumatol. 1993; 11: 85–90.

6. Packham JC, Hall MA. Premature ovarian failure in women with juvenile idiopathic arthritis (JIA). Clin Exp Rheumatol. 2003; 21: 347–350.