title: Reduction of ovarian reserve in adult patients with dermatomyositis.
abstract: OBJECTIVE
  To assess ovarian reserve markers and anti-corpus luteum (anti-CoL) antibodies in dermatomyositis (DM) patients.
  
  
  METHODS
  Forty female DM patients were invited to participate. Exclusion criteria included hormonal contraceptive use within the last six months, neoplasia associations, overlapped systemic autoimmune diseases, current pregnancy, gynaecological surgery and individual choice not to participate. The final experimental group for this cross-sectional study included 16 DM patients and 23 healthy controls, each of whom was evaluated during the early follicular phase of the menstrual cycle. Values for IgG anti-CoL (via immunoblotting), follicle stimulating hormone (FSH), estradiol, inhibin B, anti-Müllerian hormone (AMH) serum levels (via ELISA) and sonographic antral follicle count (AFC) were determined.
  
  
  RESULTS
  DM patients and controls were of comparable mean age (p>0.05). The mean age of DM onset was 29.1±4.7 years, with disease duration of 5.6±3.2 years. Menstrual cycle characteristics, comorbidity and lifestyle were similar amongst patients in both groups (p>0.05). AMH values of ≤1ng/mL (p=0.027) and AFC values (p=0.017) were significantly reduced in DM patients relative to the control group, whereas serum estradiol levels (p<0.001) were higher in DM patients compared to controls. In contrast, serum FSH and inhibin B levels, ovarian volumes, and anti-CoL antibody frequency were similar in both groups. Differences in AFC and estradiol were determined to be significant following Bonferroni correction for multiple testing.
  
  
  CONCLUSIONS
  We identified a diminished ovarian reserve in DM patients of reproductive age. Further studies are necessary to assess the idiopathic inflammatory myopathy-related factors involved in the ovarian impairment of this patient population.
authors.affiliation: Division of Rheumatology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Fernando H C
authors.initials: FH
authors.lastname: de Souza
authors.affiliation: Division of Rheumatology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Shinjo
authors.affiliation: Division of Gynaecology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Lucas Y S
authors.initials: LY
authors.lastname: Yamakami
authors.affiliation: Division of Rheumatology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Vilma S T
authors.initials: VS
authors.lastname: Viana
authors.affiliation: Division of Gynaecology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Edmund C
authors.initials: EC
authors.lastname: Baracat
authors.affiliation: Division of Rheumatology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Eloisa
authors.initials: E
authors.lastname: Bonfá
authors.affiliation: Division of Rheumatology and Paediatric Rheumatology Unit, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Clovis A
authors.initials: CA
authors.lastname: Silva
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D003338:Corpus Luteum / Q000276:immunology; D003430:Cross-Sectional Studies; D003882:Dermatomyositis / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D004958:Estradiol / Q000097:blood; D005260:Female; D043373:Follicle Stimulating Hormone, Human / Q000097:blood; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology; D007265:Inhibins / Q000097:blood; D006080:Ovarian Follicle / Q000000981:diagnostic imaging; D065851:Ovarian Reserve; D010053:Ovary / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014463:Ultrasonography
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D043373:Follicle Stimulating Hormone, Human; C422364:inhibin B; D004958:Estradiol; D007265:Inhibins; D054304:Anti-Mullerian Hormone