AB0085 ANTI-MULLERIAN HORMONE IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
Authors: Z. Alekberova, R. Goloeva, M. Cherkasova, A. Lila
Journal: Annals of the Rheumatic Diseases (2021)

Background: Anti-Mullerian hormone (AMH) is one of the key parameters for assessing reproductive function and ovarian reserve. The level of AMH correlates with the residual follicular pool in women of reproductive age. Objectives: To assess AMH levels in SLE female patients of child-bearing potential, and analyze the relationship between AMH levels and disease severity, as well as relationship between serum AMH levels and different therapeutic regimens. Methods: The study group included 12 women with SLE aged 20-40 years, and the control group - 15 age-matching healthy women. SLE diagnosis was established based on the EULAR/ACR classification criteria, 2019. The SLEDAI 2K was used to evaluate disease activity, and the SLICC index – to evaluate damage. AMH levels was measured using ELISA. AMH reference values ranged within 1.0-10.6 ng / ml. Values &lt;1.0 were interpreted as a decreased ovarian reserve. Results: SLE patients’ mean age was 33.5 [29;38] years, and control group subjects’ - 32.0 [26;35] years. Mean disease duration was 11.5 [2.8;18] years. Acute, subacute and chronic SLE was established in 33%, 17%, and 50%, respectively. Disease activity according to SLEDAI 2K was low in 25%, moderate – in 33%, and high – in 42% of pts. The SLICC damage baseline evaluation: no damage – 17%, low – 50%, medium – 16.5%, high-16.5%. Mean AMH level was 3.5 ng/ml in SLE pts, and 3.1 ng/ml - in the control group, showing no statistical difference. A decrease in ovarian reserve (AMH less than 1.0 ng / ml) was significantly more common in SLE pts - 42% vs 13% in the control group. No correlation was found between AMH levels and the SLICC damage index, AMH and SLEDAI 2K, as well as AMH and SLE duration or clinical course. Detailed analysis showed that all pts with reduced ovarian function had CP included into their therapeutic regimens; the only exclusion within this subgroup – i.e., normal AMH level-6 ng/ml and preserved ovarian function - was documented in a patient who received a cumulative CP dose of 5.6 g. In all other patients a cumulative CP dose was higher, i.e.: 7.2 g, 7.8 g, 10.6 g, and 18.4 g – 1 patient per each dose value. Three pts with low AMH levels within 0.1 -0.3 ng/ml were 39 years old, while AMH reference values in 33-39y age group are 0.77-5.24 ng / ml. Analysis of gynecological history indicate that episodes of menstrual disorders were significantly more often reported in SLE pts (50% vs 20% in controls, p =0.001), similarly, gynecological diseases were also documented in 50% of SLE pts (chronic salpyngo-oophoritis, colpitis, endometriosis and uterine endometrioma, subserous uterine myoma, cervical dysplasia, cervical erosion), meanwhile low AMH was found only in 4 SLE pts; there was only 1 subject with gynecological condition – teratoma of the ovaries – in the control group (favorable outcome – surgical removal, preserved fertility and two births after surgery). Conclusion: Ovarian reserve was significantly more often reduced in women with SLE compared to healthy controls. CP therapy negatively affects ovarian function, and most likely in a dose-dependent manner. In this study, 4 out of 5 patients with reduced ovarian function had gynecological diseases additionally compromising the ovarian reserve. Further studies are needed to clarify potential contribution of both - autoimmune inflammation and SLE therapy – into development of gynecological diseases and loss of fertility. Disclosure of Interests: None declared