Erectile dysfunction in ankylosing spondylitis patients

This was a cross sectional study approved by the local Committee of Ethics in Research. The questionnaire IIEF (International Index of Erectile Function) was applied to 40 AS patients and 40 healthy controls. AS patients had determination of disease activity (through BASDAI or Bath Ankylosing Spondylitis Disease activity index), ASDAS (Ankylosing Spondylitis Disease Activity Score, MASES or Maastricht Ankylosing Spondylitis Score and SPARCC or Spondyloarthritis Research Consortium of Canada), function (through BASFI or Bath Ankylosing Spondylitis Functional Index and HAQ or Health Assessment Questionnaire) and BASMI (Bath Ankylosing Spondylitis Metrological Index).

Results

AS patients had a median score on IIEF of 22.0 (IQR=18-25) while controls had 29 (IQR=27-30) with p<0.0001 Only 17.5% of the AS patients had no erectile dysfunction, in opposite to 87.5% of controls (p<0.0001). IIEF scores had a negative association with BASDAI (p<0.0001), HAQ (p=0.05), body mass index (P=0.03), MASES (P=0.02) and SPARCC (P=0.02) in a univariate analysis. Multiple regression showed that BASDAI was the only variable independently associated with IIEF.

Conclusion

There is a high prevalence of erectile dysfunction among AS patients that is associated with disease activity measured by BASDAI.

Erectile Dysfunction; Spondylitis, Ankylosing; Disease

Lumbar pain >3 months in patients with age <35 years. +
Sacroiliitis at imaging + one or more criteria bellow	or		HLA B27 + two or more criteria bellow
Inflammatory lumbar pain		Inflammatory bowel disease
Arthritis		Good response to NSAID
Enthesitis		Family history of Spondyloarthritis
Dactilytis		HLA B27
Psoriasis		Elevated C reactive protein

Over the past 6 months
1 - How do you rate your confidence that you could get and keep an erection?	Very low	Low	Moderate	High	Very high

	(1)	(2)	(3)	(4)	(5)
2 - When you had erections with sexual stimulation, how often were your erections hard enough for penetration?	Almost never/never	A few times (much less than half the time)	Sometimes (about half the time)	Most times (much more than half the time)	Almost always/always

	(1)	(2)	(3)	(4)	(5)
3 - During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?	Almost never/never	A few times (much less than half the time)	Sometimes (about half the time)	Most times (much more than half the time)	Almost always/always

	(1)	(2)	(3)	(4)	(5)
4 - During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?	Extremely difficult	Very difficult	Difficult	Slightly difficult	Not difficult

	(1)	(2)	(3)	(4)	(5)
5 - When you attempted sexual intercourse, how often was it satisfactory for you?	Almost never/never	A few times (much less than half the time)	Sometimes (about half the time)	Most times (much more than half the time)	Almost always/always

	(1)	(2)	(3)	(4)	(5)

IIEF Classification (points)	AS PATIENTS n=40	HEALTHY CONTROLS n=40	P
No erectile dysfunction (>26)	7 (17.5%)	35 (87.5%)	<0.0001
Mild (22 to 25)	13 (32.5%)	4 (10.0%)	0.02
Moderate (11 to 21)	15 (37.5%)	1 (2.5%)	0.0001
Severe (<6 to 10)	5 (12.5%)	0	0.054

Variable	Sample Range	Correlation with IIEF

		Pearson’s Rho	95% CI	p
Age (years)	14 - 30 (mean=21.6±4.3)	-0.16	-0.46 to 0.16	0.31
BMI (kg/m²)	17 - 43.7 (mean=7.8±5.2)	-0.34	-0.59 to -0.02	0.03
Disease duration (years)	2 - 26; (median 18.0; IQR=8.2-20.0)	0.25	-0.06 to 0.53	0.11
ESR (mm)	2 - 58 (mean=26.5±21.4)	0.12	-0.19 to 0.42	0.44
CRP (mg/dL)	0 - 58 (median=6.7;IQR=3.5-17.2)	0.07	-0.25 to 0.37	0.66
BASDAI	0-7.8 (median=2.4; IQR=1.4-4.0)	-0.61	-0.77 to -0.37	<0.0001
ASDAS CRP	0 - 4.7 (mean=2.1±1.0)	-0.30	-0.56 to 0.01	0.057
MASES	0 - 13.0 (median=0; IQR=0-2.0)	-0.10	-0.59 to -0.03	0.02
SPARCC	0 - 12.0; (median=0;IQR=0.0-1.5)	-0.34	-0.59 to -0.04	0.02
BASFI	0 - 9.2; (mean=3.5±2.7)	-0.21	-0.49 to 0.10	0.18
HAQ	0 - 2.4 (median=0.6;IQR=0.1-1.0)	-0.31	-0.57 to -0.0003	0.05
BASMI	0.7 - 7.2; (mean 4.0±1.9)	-0.10	-0.40 to 0.21	0.52

Sociedade Brasileira de Urologia Rua Bambina, 153, 22251-050 Rio de Janeiro RJ Brazil, Tel. +55 21 2539-6787, Fax: +55 21 2246-4088 - Rio de Janeiro - RJ - Brazil
E-mail: brazjurol@brazjurol.com.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence address: Renato Nisihara, MD. Unidade de Reumat. Hosp. Evangélico, Padre Anchieta. Rua João Azolin, 660 Curitiba, Paraná, 82015-040, Brasil. Fax: + 55 41 3272-7277. E-mail: renatonisihara@gmail.com