Background/Purpose: Given the obvious female predominance of rheumatic diseases, significant attention has already been drawn to the impact of these conditions on female sexual function. Nevertheless, rheumatic diseases can also present with challenges that are unique to male sexual function and thus, we aimed to systematically review the prevalence of erectile dysfunction in rheumatic diseases.

Methods: Using Medline, EMBASE, and Web of Science electronic databases, we performed a systematic review to identify original articles evaluating the prevalence of erectile dysfunction, assessed using the validated international index of erectile function (IIEF-5) questionnaire, in men with rheumatic diseases, including systemic sclerosis (SSc), systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and ankylosing spondylitis (AS). The search was restricted to English articles and performed in May 2016. We hand-searched reference lists, review articles, and grey literature for relevant articles not captured by the electronic searches.

Results: Our literature search identified 54 studies of which 34 were selected for full-text review. Of the potentially relevant studies retrieved, 12 studies were included in the final analysis. Five studies (n=219) focused on patients with SSc and reported ED prevalence ranging from 81-88%. In these studies, ED was found to correlate with disease severity and was associated with ultrasonographic evidence of penile vascular impairment. Comparatively, in RA (3 studies, n=138) and AS subjects (4 studies, n=272), ED prevalence ranged respectively from 46-54% and 12-42%. In AS, increased Bath Ankylosing Spondylitis Disease Activity Index scores, duration of morning stiffness, and disease duration were associated with ED. In the aforementioned studies, the age-matched healthy control population had ED rates ranging from 11-27%. Of note, only 2 studies (n=35) examined SLE and/or antiphospholipid-antibodies-positive subjects but standardized questionnaires were not used to evaluate ED and thus, these studies were excluded.

Conclusion: Men with SSc, RA, and AS have a substantially higher prevalence of ED compared to age-matched healthy controls. Given the importance of normal erectile function in sexual health and quality of life, clinicians should be aware of the increased prevalence of ED in men with rheumatic diseases and offer preventative, as well as therapeutic strategies to minimize its impact.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/erectile-dysfunction-in-men-with-rheumatic-diseases-a-systematic-review/