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Recurrent amenorrhoea and reversible ovarian failure: case report A 35-year-old woman developed recurrent amenorrhoea and reversible ovarian failure during treatment with adalimumab, etanercept and methotrexate for psoriatic arthritis [routes and dosages not stated; not all time to reaction onsets clearly stated]. The woman had menarche at the age of 13 years and regular 28 days menstrual cycle. She had given birth to two children normally. She had psoriatic arthritis diagnosed at age of 8 years, along with back pain and dactylitis. Initially, she received sulfasalazine and unspecified non-steroidal anti-inflammatory drugs. On assessing her symptoms, she was switched to methotrexate therapy. However, five months later, she developed hot flushes and amenorrhoea. Laboratory investigation revealed raised FSH level, raised LH level and low level of oestradiol. Her amenorrhoea persisted for four cycles. Therefore, in March 2009, the woman’s treatment with methotrexate was switched to adalimumab. Following two months, her menses started again. Thereafter, she continued to receive adalimumab therapy intermittently for nine years. During adalimumab therapy, she experienced irregular cycles and climacteric symptoms. A progesterone withdrawal test revealed positive result. In April 2013, at the age of 38 years, her treatment with adalimumab was switched to etanercept. Subsequently, she again developed amenorrhoea and of climacteric symptoms. From her menstrual cycles pattern, it was suspected that the adalimumab, etanercept and methotrexate caused reversible ovarian failure. This time her FSH was 82.2 IU/L and oestradiol level was less than 12 pg/mL. Thereafter, her treatment with etanercept was discontinued. Subsequently, the woman re-initiated etanercept and then again discontinued. A progesterone withdrawal test induced menses. Causality relationship based on the Naranjo probability scale showed a score of 7 (probable) for etanercept and 5 for both methotrexate and adalimumab. Ladhari C, et al. Recurrent amenorrhoea associated with disease-modifying anti-rheumatic drugs: A case report. Clinical and Experimental Rheumatology 38: 1035-1036, No. 803516354 5, Sep 2020. Available from: URL: https://www.clinexprheumatol.org/abstract.asp?a=14921

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Reactions 21 Nov 2020 No. 1831