Open Access Open Badges Research article

Erectile dysfunction is frequent in systemic sclerosis and associated with severe disease: a study of the EULAR Scleroderma Trial and Research group

Chingching Foocharoen1, Alan Tyndall1, Eric Hachulla2, Edoardo Rosato3, Yannick Allanore4, Dominique Farge-Bancel5, Paola Caramaschi6, Paolo Airó7, Starovojtova M Nikolaevna8, José António Pereira da Silva9, Bojana Stamenkovic10, Gabriela Riemekasten11, Simona Rednic12, Jean Sibilia13, Piotr Wiland14, Ingo Tarner15, Vanessa Smith16, Anna T Onken17, Walid Ahmed Abdel Atty Mohamed18, Oliver Distler19, Jadranka Morović-Vergles20, Andrea Himsel21, Paloma Garcia de la Peña Lefebvre22, Thomas Hügle1 and Ulrich A Walker1*

Author affiliations

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

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Citation and License

Arthritis Research & Therapy 2012, 14:R37  doi:10.1186/ar3748

Published: 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.