Erectile dysfunction is frequent in systemic sclerosis and associated with severe disease: a study of the EULAR Scleroderma Trial and Research group
1 Department of Rheumatology, Basel University, Burgfelderstrasse 101, Basel 4012, Switzerland
2 Department of Internal Medicine, Hôpital Claude Huriez, Place de Verdun, Lille 59035, France
3 Centro per la Sclerosi Sistemica - Dipartimento di Medicina, Università 'La Sapienza', Viale del Policlinico 155, Rome 00185, Italy
4 Rhumatologie A, Hôpital Cochin, Université Paris Descartes, Saint-Vincent-De-Paul La Roche-Guyon 27, rue du Fg Saint-Jacques, Paris 75679, France
5 Department of Internal Medicine, Hospital Saint Louis, 1 avenue Claude Vellefaux, Paris 75010, France
6 Rheumatology Unit, University of Verona, Piazzale LA Scuro 10, Verona 37134, Italy
7 Rheumatology and Clinical Immunology Service, Spedali Civili di Brescia, P. le Spedali Civili 1, Brescia 25123, Italy
8 Institute of Rheumatology, Russian Academy of Medical Science, Kashirskoye Shosse, 34 A, Moscow 115522, Russia
9 Hospitais da Universidade, Coimbra 3000-075, Portugal
10 Institute for Prevention, Treatment and Rehabilitation of Rheumatic Disease, Srpskih Junaka 2, Niska Banja 18205, Serbia and Montenegro
11 Department of Rheumatology, Charité University Hospital, Schumannstraße 20/21, Berlin 10117, Germany
12 Rheumatology Clinic, University of Medicine & Pharmacy 'Luliu Hatieganu' Cluj, Str. Clinicilor nr. 2-4, Cluj-Napoca 400006, Romania
13 Department of Rheumatology, University Hospital of Strasbourg, 1 avenue Molière 83049, Strasbourg 67098, France
14 Department of Rheumatology and Internal Diseases, Wroclaw University of Medicine, Ul. Borowska 213, Wroclaw 50-556, Poland
15 Department of Rheumatology and Clinical Immunology, Justus-Liebig-University, Benekestraße 2-8, Bad Nauheim 61231, Germany
16 Department of Rheumatology, University of Ghent, De Pintelaan 185, Ghent 9000, Belgium
17 Department of Dermatology and Allergy, TU Munich, Biedersteiner Straße 29, Munich 80802, Germany
18 Unit of Rheumatology, Alexandria University Student Hospital, Champlion Square Mazarita, Alexandria, Egypt
19 Department of Rheumatology, University Hospital Zurich, Gloriastrasse 25, Zurich 8032, Switzerland
20 Division of Clinical Immunology and Rheumatology, University Hospital Dubrava, Av. G. Šuška 5, Zagreb 10000, Croatia
21 Department of Rheumatology, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
22 Hospital Madrid Norte, c/OÑA N° 10, Madrid 28050, Spain
Arthritis Research & Therapy 2012, 14:R37 doi:10.1186/ar3748Published: 20 February 2012
Erectile dysfunction (ED) is common in men with systemic sclerosis (SSc) but the demographics, risk factors and treatment coverage for ED are not well known.
This study was carried out prospectively in the multinational EULAR Scleroderma Trial and Research database by amending the electronic data-entry system with the International Index of Erectile Function-5 and items related to ED risk factors and treatment. Centres participating in this EULAR Scleroderma Trial and Research substudy were asked to recruit patients consecutively.
Of the 130 men studied, only 23 (17.7%) had a normal International Index of Erectile Function-5 score. Thirty-eight per cent of all participants had severe ED (International Index of Erectile Function-5 score ≤ 7). Men with ED were significantly older than subjects without ED (54.8 years vs. 43.3 years, P < 0.001) and more frequently had simultaneous non-SSc-related risk factors such as alcohol consumption. In 82% of SSc patients, the onset of ED was after the manifestation of the first non-Raynaud's symptom (median delay 4.1 years). ED was associated with severe cutaneous, muscular or renal involvement of SSc, elevated pulmonary pressures and restrictive lung disease. ED was treated in only 27.8% of men. The most common treatment was sildenafil, whose efficacy is not established in ED of SSc patients.
Severe ED is a common and early problem in men with SSc. Physicians should address modifiable risk factors actively. More research into the pathophysiology, longitudinal development, treatment and psychosocial impact of ED is needed.