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Clinical Rheumatology

, Volume 37, Issue 10, pp 2869–2873 | Cite as

Non-steroidal anti-inflammatory drug induces luteinized unruptured follicle syndrome in young female juvenile idiopathic arthritis patients

  • Renato B. Tomioka
  • Gabriela R. V. Ferreira
  • Nadia E. Aikawa
  • Gustavo A. R. Maciel
  • Paulo C. Serafini
  • Adriana M. Sallum
  • Lucia M. A. Campos
  • Claudia Goldestein-Schainberg
  • Eloisa Bonfá
  • Clovis A. Silva
Brief Report

Abstract

To assess prospectively luteinized unruptured follicle (LUF) syndrome in juvenile idiopathic arthritis (JIA) patients with and without non-steroidal anti-inflammatory drugs (NSAIDs) and healthy controls. Twenty-three adolescent and young adult female JIA patients (ILAR criteria) and 11 female healthy subjects were studied by pelvic ultrasound monitoring for follicular development and ovulation in one menstrual cycle. LUF syndrome was prospectively investigated by pelvic ultrasound with a dominant ovarian follicle without signs of follicular rupture, with elevation of serum progesterone in the luteal phase of the menstrual cycle and luteinizing hormone (LH) detected in the urine. Comparison between JIA patients with (n = 8) vs. without NSAIDs (n = 15) and healthy controls (n = 11) revealed that LUF syndrome was significantly higher in the former group (2 (25%) vs. 0% vs. 0%, p = 0.049). These two patients with LUF syndrome had normal menstrual cycles without reduced ovarian reserve, and they were under naproxen 500 mg bid during the menstrual cycle. Disease duration was comparable in JIA with and without NSAIDs [19.8 (4.4–25) vs. 13 (3.1–33) years, p = 0.232]. Further comparison between JIA patients with and without NSAIDs and healthy controls showed similar mean anti-Müllerian hormone levels (p = 0.909), estradiol (p = 0.436), FSH (p = 0.662), LH (p = 0.686), and mean antral follicle count (p = 0.240) and ovarian volume (p = 0.363). No differences were evidenced in three groups regarding Caucasian race, body mass index, duration, and length of menstrual cycles (p > 0.05). This is the first study to identify that JIA patients have a high frequency of LUF without impaired ovarian reserve. Future prospective studies are necessary to determine if chronic/continuous use of NSAIDs in JIA will have an impact in these patients’ fertility.

Keywords

Fertility Juvenile idiopathic arthritis Luteinized unruptured follicle syndrome Non-steroidal anti-inflammatory drugs 

Notes

Funding

This study was supported by grants from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq 305068/2014-8 to EB and 303422/2015-7 to CAS), Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP 2014/14806-0 and 2015/03756-4 to EB and CAS), Federico Foundation (to CAS) and by Núcleo de Apoio à Pesquisa “Saúde da Criança e do Adolescente” da USP (NAP-CriAd) to CAS.

Compliance with ethical standards

The Local Ethics Committee of our tertiary service approved the study, and an informed consent was obtained from all participants and their legal guardian.

Disclosure

None.

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Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  • Renato B. Tomioka
    • 1
    • 2
  • Gabriela R. V. Ferreira
    • 3
  • Nadia E. Aikawa
    • 1
    • 3
  • Gustavo A. R. Maciel
    • 2
  • Paulo C. Serafini
    • 2
  • Adriana M. Sallum
    • 3
  • Lucia M. A. Campos
    • 3
  • Claudia Goldestein-Schainberg
    • 1
  • Eloisa Bonfá
    • 1
  • Clovis A. Silva
    • 1
    • 3
  1. 1.Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSão PauloBrazil
  2. 2.Division of Gynecology, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
  3. 3.Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil

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