Sexual dysfunction in rheumatoid arthritis patients: arthritis and beyond

Uncovering the link between inflammatory rheumatic diseases and male reproductive health: a perspective on male infertility and sexual dysfunction

Inflammatory rheumatic diseases (IRDs) refer to a range of persistent disorders that have a major influence on several physiological systems. Although there is much evidence connecting IRDs to sexual dysfunction and fertility problems, research specifically focusing on male infertility in relation to these diseases is sparse. This review addresses the complicated connection between IRDs and male infertility, emphasising the physiological, psychological, and pharmacological aspects that influence reproductive health outcomes in men with rheumatic conditions. We explore the effects of IRDs and their treatments on many facets of male reproductive well-being, encompassing sexual functionality, semen characteristics, and hormonal balance. Additionally, we present a comprehensive analysis of the present knowledge on the impact of several categories of anti-rheumatic drugs on male reproductive function. Although there is an increasing awareness of the need of addressing reproductive concerns in individuals IRDs, there is a noticeable lack of research especially dedicated to male infertility. Moving forward, more comprehensive research is needed to determine the prevalence, risk factors, and mechanisms driving reproductive difficulties in males with IRDs. We can better assist the reproductive health requirements of male IRD patients by expanding our understanding of male infertility in the setting of rheumatic disorders and implementing holistic methods to care.

Biopsychosocial factors are associated with impaired sexual function in Mexican patients with rheumatoid arthritis

BACKGROUND

Rheumatoid arthritis (RA) is a chronic disease with worldwide representation that impacts every domain of a patient´s life, extending to sexual and reproductive domains. The study characterized sexual health (SH) and reproductive health (RH) in Mexican RA outpatients and identified factors associated with impaired sexual function (ISF).

METHODS

From September 1, 2020-January 31, 2022, consecutive RA participants had semi-structured interviews focusing on their SH and RH biographies, and self-administered questionnaires were applied to assess patient-reported outcomes, including fatigue with the Functional Assessment of Chronic Illness Therapy-Fatigue scale (FACIT-F). ISF was defined based on published cut-offs of the International Index of Erectile Function (IIEF) in males and the Female Sexual Function Index (FSFI) in females (≥1 sexual intercourse in the last four weeks was required for index scoring). Multivariable logistic regression analysis was used to identify the factors associated with ISF.

RESULTS

There were 268 participants, and 246 (91.8%) were females. Participants had 13 years of disease duration. Among females, 151 (61.4%) had FSFI applied, and the satisfaction domain was impaired in 111 (73.5%). Among males (N = 22), 17 (77.3%) had IIEF applied, and erectile dysfunction was present in 5 (29.4%). Almost half of the participants denied using a family planning method, were in their 50s, and receiving teratogenic drugs; 89.7% of the participants had children. ISF was detected in 94 (62.3%) females and 3 (17.6%) males. Male sex (aOR: 0.07, 95%CI: 0.01-0.36, p = 0.001), FACIT-F score (aOR: 0.96, 95%CI: 0.92-1.00, p = 0.03), and cohabitation with the couple (aOR: 0.32, 95%CI: 0.11-0.96, p = 0.04) were associated with ISF.

CONCLUSIONS

We observed a disproportionate burden of ISF among women with RA compared to male participants. Male sex, lesser fatigue, and cohabitation with the couple were protective against ISF. Regardless of the prevalent use of teratogenic medications, contraceptive use was suboptimal among the participants.

Arthritis increases the risk of erectile dysfunction: Results from the NHANES 2001-2004

Objective

This study assessed the association between erectile dysfunction (ED) and arthritis.

Methods

Weighted logistic regression and subgroup analyses were used to investigate the association between arthritis incidence and ED among participants in the 2001-2004 National Health and Nutrition Examination Survey database.

Results

Among the participants, 27.8% and 18.5% had a self-reported history of ED and arthritis, respectively. ED was associated with arthritis (odds ratio [OR]=4.00; 95% confidence interval [CI]: 3.20-4.99; p<0.001], which remained significant after adjustment (OR=1.42, 95% CI: 1.00-1.96; p<0.001). Stratified by type of arthritis, after full adjustment, osteoarthritis remained significant (OR=1.11; 95% CI: 1.03-1.20; p=0.017), and rheumatoid arthritis (OR=1.03, 95% CI: 0.93-1.13; p= 0.5) and other arthritis (OR=1.04, 95% CI: 0.98-1.11; p=0.2) were not significantly correlated with ED. Multiple inference analyses confirmed the robustness of the results.

Conclusion

Our study showed that arthritis was strongly associated with ED. There is an urgent need to raise awareness and conduct additional research on the reasons behind this association in order to implement more scientific and rational treatment programs for patients with ED and arthritis.

Is erectile dysfunction associated with osteoarthritis and rheumatoid arthritis? Insights from a population-based study

Background

The correlation between osteoarthritis (OA) and rheumatoid arthritis (RA), both significant components of arthritis, and erectile dysfunction (ED) has yet to be thoroughly investigated.

Aim

In this study we aimed to assess the association of OA and RA with ED.

Methods

In this observational study we used data from the National Health and Nutrition Examination Survey, which was conducted between 2001 and 2004. Various statistical analyses were employed to investigate the associations of OA and RA with ED, including multivariable logistic regression analysis and subgroup analysis.

Outcomes

The primary outcome for this investigation was arthritis as assessed through self-reporting.

Results

In this comprehensive nationally representative survey spanning 4 years, our findings revealed a notably elevated incidence of ED within both OA and RA populations in comparison to the general population. Additional research is imperative to provide a deeper understanding of these correlations and their potential implications for both pathogenesis and treatment strategies.

Clinical Implications

The research outcomes reported here may serve as a valuable guide for clinicians to assist OA and RA patientsin staying vigilant in addressing their sexual health concerns.

Strengths and Limitations

We explored the association of OA and RA with ED. However, this is only a cross-sectional study.

Conclusion

In this comprehensive nationally representative survey spanning 4 years, our findings revealed a notably elevated incidence of ED within both OA and RA patient populations in comparison to the general population. Ongoing research is imperative to provide a deeper understanding of these correlations.

Exploring complex links: inflammatory rheumatic diseases and men's health

This article examines the complex interactions between inflammatory rheumatic diseases (IRDs) and men's health. It delves into the effects of IRDs on reproductive health, erectile dysfunction, prostate involvement, male osteoporosis, body composition, physical activity, and coping mechanisms. The findings show that the prevalence of sexual dysfunction varies among different diseases, underscoring the necessity for comprehensive counseling. The link between IRDs and prostate health, with a substantial rise in benign prostatic hyperplasia among IRD patients, demonstrates the condition's importance. In contrast to popular belief, osteoporosis mostly affects women; the current study highlights the growing identification of male osteoporosis, particularly in the setting of IRDs. Male RA patients had a significant loss in bone mineral density, highlighting the importance of increasing awareness and tailored therapy to address osteoporosis in men. IRDs affect body composition, with male RA patients showing imbalances characterized by decreased lean body mass and increased fat mass. Given the dynamic nature of these conditions, coping with IRDs necessitates thorough and individualized diversified approaches. The complex link between IRDs and men's health demands continuing research, including longitudinal studies and tailored therapies. The essay promotes a patient-centered approach, recognizing the unique obstacles that males with IRDs confront.

Patient-reported outcomes in RA patients treated with tofacitinib or bDMARDs in real-life conditions in two Latin American countries

OBJECTIVE

To describe efficacy, safety, and patient-reported outcomes (PROs) in patients with rheumatoid arthritis (RA) with an inadequate response to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) treated with tofacitinib or biological DMARDs (bDMARDs) in real-life conditions.

METHODS

A noninterventional study was performed between March 2017 and September 2019 at 13 sites in Colombia and Peru. Outcomes measured at baseline and at the 6-month follow-up were disease activity (RAPID3 [Routine Assessment of Patients Index Data] score), functional status (HAQ-DI [Health Assessment Questionnaire] score), and quality of life (EQ-5D-3L [EuroQol Questionnaire]). The Disease Activity Score-28 (DAS28-ESR) and frequency of adverse events (AEs) were also reported. Unadjusted and adjusted differences from baseline were estimated and expressed as the least squares mean difference (LSMD).

RESULTS

Data from 100 patients treated with tofacitinib and 70 patients with bDMARDs were collected. At baseline, the patients' mean age was 53.53 years (SD 13.77), the mean disease duration was 6.31 years (SD 7.01). The change from baseline at month 6 was not statistically significant different in the adjusted LSMD [SD] for tofacitinib vs. bDMARDs for RAPID3 score (-2.55[.30] vs. -2.52[.26]), HAQ-DI score (-.56[.07] vs. -.50[.08]), EQ-5D-3L score (.39[.04] vs. .37[.04]) and DAS28-ESR (-2.37[.22] vs. -2.77[.20]). Patients from both groups presented similar proportions of nonserious and serious AEs. No deaths were reported.

CONCLUSION

Changes from baseline were not statistically significantly different between tofacitinib and bDMARDs in terms of RAPID3 scores and secondary outcomes. Patients from both groups presented similar proportions of nonserious and serious AEs.

CLINICAL TRIAL NUMBER

NCT03073109.

Evaluation of the sexual sphere in patients with psoriatic arthritis

INTRODUCTION

Psoriatic arthritis (PsA) is a chronic inflammatory disorder that primarily affects the joints and entheses. In addition, it is associated with depressive syndrome (DS), cardiovascular disease, hypertension (HT), diabetes mellitus (DM), obesity and psoriasis (Pso). There are few studies aimed to analyze the association of the involvement of the musculoskeletal system with sexual function (SF).

METHODS

A cross-sectional observational study was proposed in patients diagnosed with PsA, to whom self-administered validated questionnaires were applied to determine alterations in SF: MGH-SFQ and CSFQ-14, which assess the 4 domains of sexual function; Qualisex and DLQI designed for joint and dermatological pathology respectively, which explore sexual aspects. The objective was to describe the existence of altered sexual function in patients with PsA; analyze the association between sociodemographic characteristics, comorbidities (Pso, DS, cardiovascular risk factors) and the treatments of patients on SF; and describe differences of SF according to gender.

RESULTS

72 patients were evaluated. It was observed that the variables of patients with PsA that were associated with lower scores in SF were gender and age in the CSFQ-14 and MGH-SFQ; annual incomes, treatment with NSAIDs, DL and depression were associated with worse results in some domains of the sexual sphere.

CONCLUSIONS

Patients with PsA had impaired SF, especially women, elder patiens, those with low annual incomes, DL and emotional disorders. Anti-inflammatory treatments were associated with better SF. Globally, the chronic disease and the psychological burden behaved as factors associated with sexual dysfunction.

Prevalence of Sexual Dysfunction in Mexican Women with Rheumatoid Arthritis

We estimate the prevalence and identified the associated factors of sexual dysfunction in Mexican women with rheumatoid arthritis (RA). A cross-sectional survey was applied to 100 women with RA and compared with 100 healthy, sexually active, adult women. Assessments included an interview using the Female Sexual Function Index (FSFI). Assessment of factors related to sexual dysfunction included gynecologic characteristics, disease activity (DAS-28), and functioning questionnaire (HAQ-DI). Mann-Whitney U test and the Chi-square test were used to compare medians and proportions between the groups. A multivariate logistic regression was performed using sexual dysfunction according to impairments shown by the FSFI. A higher proportion of RA patients had sexual dysfunction compared with controls. Domains with higher impairment in RA patients were desire, arousal, lubrication, and orgasm. A decrease in sexual function correlated with age (r = −0.365 p < 0.001) and higher scores in HAQ-DI (r = −0.261 p = 0.009). Those patients with a higher disability had higher impairments in desire, arousal, lubrication, and satisfaction. In the multivariate analysis, menopause was associated with sexual dysfunction (OR: 10.02; 95% CI: 1.05−95.40, p = 0.04), whereas use of methotrexate was a protective factor (OR: 0.32; 95% CI: 0.11−0.92, p = 0.03). Sexual dysfunction is highly prevalent in Mexican women with RA. Clinicians should systematically evaluate the impairment in sexual function in women with RA.

The impact of polymyalgia rheumatica on intimate sexual relationships: findings from the PMR Cohort Study

Objective

The aim was to determine the impact of PMR on intimate and sexual relationships over time.

Methods

The PMR Cohort study is a longitudinal study of patients with incident PMR in English primary care. Participants were sent questionnaires about their PMR symptoms, treatments and overall health, including an item about how their PMR symptoms affected intimate and sexual relationships. The proportions reporting the relevance of intimate and sexual relationships, the effect of PMR on these relationships and the associations with PMR symptoms and general health were explored.

Results

The baseline survey was completed by 652 of 739 patients (response 90.1%), with 446 of 576 (78.0%) responding at 2 years. The mean age of respondents was 72.4 years, and 62.2% were female. At baseline, 363 of 640 (56.7%) respondents reported that intimate and sexual relationships were not relevant to them. One hundred and thirteen of 277 (40.8%) respondents reported that PMR had a large effect on intimate relationships. This proportion decreased over time in those responding to 12- and 24-month surveys, but continued to be associated with younger age, male gender, worse PMR symptoms, poorer physical function and worse mental health.

Conclusion

Intimate and sexual relationships are increasingly recognized as important for healthy ageing, and health professionals should consider this as part of a holistic approach to the management of PMR.

Study registration

UKCRN ID16477.

Sexual Dysfunction and Quality of Life in Patients with Rheumatoid Arthritis

Background: Sexual health is a major component of human well-being. As repeatedly shown in research, satisfaction with sex life and sexual fulfillment correlate positively with quality of life (QoL) in most of its aspects. It is thus true that a reduced quality of one’s sex life and lack of sexual fulfillment can contribute to poorer QoL overall. The aim of this study is to describe an assessment of sexual dysfunction and factors affecting sexual dysfunctions of patients with rheumatoid arthritis (RA). Material and methods: 171 consecutive RA patients (mean age 48.3 ± 14.6) attending the rheumatology outpatient clinic. Standardized questionnaires used in the study were the sexological questionnaire, WHOQOL-BREF to assess QoL level, Disease Acceptance Scale, and VAS scale to assess pain intensity. Results: The mean duration of the disease in the study group was 13 ± 9 years, mean score of subjective assessment of mobility was 6.2 ± 1.6, and the mean score of the DAS-28 was 4.0 ± 1.9. The study group presented a mean level of disease acceptance (AIS 29.6 ± 11.6). The comparative analysis showed significant differences in reaching orgasm and declared sexual dysfunctions. These problems occurred more often in women than in men (34.2% vs. 18% and 43% vs. 40%, respectively). In univariate analysis, factors correlating positively with the frequency of declaring sexual dysfunction were subjective motor score less < 6 points, AIS < 36 points, WHOQOL-BREF < 59 points, disease activity ≥3.5 points, and VAS > 3. In multivariate logistic regression analysis, independent factors positively correlating with frequency of sexual dysfunction declaration were general QoL (β = 1.255; p = 0.035) and pain limiting social life (β = 1.564; p = 0.030). The absence of comorbidities correlated negatively and reduced the prevalence of sexual dysfunction (β = −1.030; p = 0.043). Patients with reduced QoL and patients with pain limiting social life had 3.5 and 4.8 times higher risk of sexual dysfunction than other patients, respectively. In contrast, those without comorbidities were 2.8 times more likely to be free of sexual dysfunction than those diagnosed with other chronic diseases besides RA. Conclusions: Sexual dysfunction is an emerging problem in both men and women with RA. The absence of comorbidities is an independent determinant of sexual dysfunction, whereas poor QoL and pain limiting social life are independent determinants that exacerbate sexual dysfunction in both genders.

Evaluation of sexual dysfunction and its predictive factors in female and male patients with rheumatoid arthritis

Background

Rheumatoid arthritis (RA) is a common disabling joint disease affecting both males and females. Sexual dysfunction (SD) is a common association with RA. The aim of this work was to study the prevalence and predictors of sexual dysfunction in male and female patients with rheumatoid arthritis.

Results

The mean age of female patients was 32.1 years and 39.7 years for males. The prevalence of sexual dysfunction was higher in RA female patients than controls, 62.1% versus 41.2% respectively (P ≤ 0.05). The prevalence of global sexual dysfunction was higher in RA male patients than controls, 63.8% versus 47.5% respectively (P ≤ 0.05). Predictors of sexual dysfunction in female RA patients were the number of children, BMI, disease duration, DAS score, HADs-D score, HAQ score, VAS score, joint deformity, and the number of drugs. Predictors of sexual dysfunction in male RA patients were age, disease duration, DAS score, HAQ score, VAS score, and the number of drugs.

Conclusion

SD is prevalent in RA patients. Disease activity, pain, depression, and disturbed quality of life affect nearly all domains of sexual functions in female and male patients.

A cross-sectional study of sexual dysfunction in chinese mainland female patients with rheumatoid arthritis

Objectives

This study aims to investigate the effects of rheumatoid arthritis (RA) on Chinese mainland female patients’ sexual function compared with healthy subjects and to determine the risk factors of sexual dysfunction.

Patients and methods

A total of 151 female RA patients (mean age: 46.3±8.6 years) and 146 healthy female controls (mean age 45.7±7.6 years) were included in this cross-sectional study whose data were collected consecutively by questionnaires between November 2017 and June 2019. Data were collected by using demographics, disease-related information, Female Sexual Function Index, Dyadic Adjustment Scale, Medical Coping Modes Questionnaire, other psychological parameters and the Short Form-36.

Results

Our results showed that the prevalence of female sexual dysfunction was 67.5% in RA patients, which was significantly higher than the controls (54.1%) (p<0.05). Body mass index, resignation coping style, physical component summary, marital dysfunction and postmenopausal status were significant correlation factors by backward stepwise binary logistic regression.

Conclusion

Rheumatoid arthritis negatively affected sexual function of patients who had considerably impaired sexual function compared to controls.

Rheumatology-led pregnancy clinic: men perspective

The birth of reproductive rheumatology as a subject of interest in rheumatology has led to improvement of clinical care for patients living with autoimmune rheumatic diseases and paved the way towards setting a specialized pregnancy service within the standard rheumatology practice. In contrast to women, where there has been wealth of literature regarding pregnancy, lactation, and birth outcomes, there is not as much focusing on male sexual health and outcomes among inflammatory arthritis patients. Challenges such as decrease ability to conceive, impaired fertility, erectile dysfunction, and other sexual problems have been raised by male patients living with autoimmune rheumatic diseases. This broad scope gives the reproductive health concept in men another expansion with views to include sexual health problems screening among men attending the standard outpatient rheumatology clinics. This article adds to the paucity of real-life experience and aims at discussing the sexual health from the men perspective and provides a practical approach towards screening, and assessment of men living with autoimmune diseases in standard day to day practice.

Improved Sexual Function After Total Hip and Knee Arthroplasty for Osteoarthritis

Osteoarthritis of the hip and knee is known to affect sexual activity. For patients with osteoarthritis, pain during sexual activity can lead to decreased quality of life and other associated health issues. The authors designed a prospective study to evaluate the effect of total hip arthroplasty and total knee arthroplasty on the psychosocial and physical aspects of sexuality pre- and postoperatively. Between April 2009 and December 2011, patients received questionnaires in the mail preoperatively. They were asked to return the preoperative questionnaire before surgery and the postoperative questionnaire 6 months after surgery. Data were analyzed to evaluate the psychosocial and physical aspects of sexuality and participants' subjective assessment of their appearance. Preoperatively, 91% and 67% of patients reported psychosocial and physical issues, respectively. After the arthroplasty procedure, 84% (P<.001) and 47% (P<.001) of patients reported improvement psychosocially and physically, respectively. Of the patients, 16% reported that arthroplasty adversely affected sexual function, with their predominant fear being joint damage (63%). A greater number of women and patients undergoing hip procedures reported improvement in sexual activity after surgery compared with men (P=.02) and patients undergoing knee procedures (P=.002). Both hip and knee osteoarthritis and arthroplasty had a significant effect on overall sexual function-psychosocially, physically, and in terms of patients' assessment of their external appearance-with higher rates of improvement seen after hip arthroplasty. Because of the effect of osteoarthritis and arthroplasty on sexual function, this topic should be addressed both pre- and postoperatively. [Orthopedics. 2021;44(2):111-116.].

Sexual Dysfunction and its Determinants in Male Patients with Rheumatoid Arthritis

BACKGROUND: Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease affects about 0.5–1% of adults. Sexuality is an integral part of human quality of life and responsible for our individual welfare, study the association between them is highly important as many studies revealed that sexuality is greatly affected in RA patients. AIM: This study aims to determine the possible different risk factors for sexual dysfunction (SD) in RA and to study the magnitude of SD among RA male patients. METHODS: This is a case–control study carried on 60 males – aged between 18–45 years – attending Family Medicine and Rheumatology Clinic in Kasr Alainy, Cairo University, Egypt. Participants were divided into case and control groups, both groups were matched regarding socioeconomic status. All participants were evaluated for sexual function using international index of erectile function (IIEF), psychological state using patient health questionnaire (PHQ9), disease-related disability using health assessment questionnaire, disease severity using disease activity score 28, and serum testosterone level was assessed. RESULTS: There was a statistically significant difference between both groups regarding IIEF (OR o’s SD among patients were 1.66), PHQ9, and serum testosterone (p = 0.005). There was highly statistically significant negative correlation between sexual problems and depression, disease caused disability, RA duration and there was highly statistically significant positive correlation between sexual problems and serum hormonal level. CONCLUSION: Sexual problems are a prominent problem in males who suffer from RA. Sexual function was significant associated with disease activity, depression, quality of life, and with lower levels of total and free testosterone.

Beyond Rheumatoid Arthritis Evaluation: What are We Missing?

Rheumatoid Arthritis (RA) is a chronic inflammatory autoimmune systemic disease that preferentially affects small and large joints with a progressive course and can become deforming and disabling. In recent years, much progress has been made in the evaluation of inflammation and disease activity, however, there are other factors that have a high impact on the quality of life of these patients, such as depression, anxiety, fatigue, sleep disorders, suicidal behavior, fibromyalgia, sexual activity, sarcopenia, frailty, cachexia and obesity that are not always evaluated by rheumatologists. This review shows that the evaluation and timely detection of these aspects in patients with RA could interfere with the prognosis and improve their quality of life.

Views of Mexican outpatients with rheumatoid arthritis on sexual and reproductive health: A cross-sectional study

BACKGROUND

Rheumatoid arthritis (RA) impacts sexual and reproductive health (SRH), which is a prominent component of a patient´s quality of life and highly influenced by the cultural background. The aim of the study was to explore the interest of Mexican outpatients with RA in SRH and to examine patient view on SRH.

METHODS

This cross-sectional study surveyed 303 consecutive outpatients with RA on their perceptions of SRH importance, SRH satisfaction, access to SRH information, preferences regarding SRH communication with healthcare professionals, and understanding of SRH (qualitative open-ended descriptions). Descriptive statistics and inferential analysis were used. Patient knowledge of each dimension of SRH was rated based on pre-specified criteria. Two assessors assigned ten major themes to each patient´s description of both dimensions of SRH.

RESULTS

Patients perceived their SRH as an important component of their general health and wished to address the topic, although few had access to such communication. Female patients assigned lesser importance to SRH, showed lesser degree of satisfaction with SRH, and expressed preference for a truthful physician. Age showed a linear association with individual survey responses, except for satisfaction with reproductive health dimension. There was a linear association between increased age and decreased years of formal education with a lower level of SRH knowledge. Ten major themes emerged for each of the two dimensions of the SRH construct, although most individual descriptions were assigned to one or two major themes.

CONCLUSIONS

Further education and assessment of SRH in Mexican patients with RA is warranted.

Erectile Dysfunction and Cardiovascular Risk in Men With Rheumatoid Arthritis: A Population-based Cohort Study

OBJECTIVE

Both erectile dysfunction (ED) and rheumatoid arthritis (RA) are associated with increased cardiovascular (CV) risk. It is unknown if these diagnoses are associated or if their combination confers additional CV risk. We aimed to define the incidence of ED in RA, and to determine if ED correlates with increased CV risk in RA.

METHODS

Medical information concerning RA, ED, and CV diagnoses for men with RA (n = 260) diagnosed in Olmsted County, Minnesota, and age-matched male comparators was extracted from a comprehensive medical record system.

RESULTS

ED incidence was similar between the RA cohort and comparators (HR 0.80, 95% CI 0.55-1.16). In men with RA, ED diagnosis was associated with a trend toward an increase in peripheral arterial disease (HR 2.22, 95% CI 0.98-5.03) and a significantly decreased rate of myocardial infarction (HR 0.26, 95% CI 0.07-0.90), heart failure (HR 0.49, 95% CI 0.25-0.94), and death (HR 0.56; 95% CI 0.36-0.87). In men with RA and ED, phosphodiesterase-5 inhibitor use was associated with a decreased risk of death (HR 0.35, 95% CI 0.16-0.79), with a trending decreased risk of some CV diagnoses.

CONCLUSION

Incidence of ED was not statistically increased in RA. Although patients with both RA and ED had a similar overall CV risk to those with RA alone, men with both RA and ED had decreased risk of heart failure, myocardial infarction, and death, as well as an increased risk of peripheral arterial disease. Further studies are needed to clarify these associations and their implications for pathogenesis and therapeutics.

The effect of suffering from rheumatoid arthritis, systemic lupus erythematosus, and back pain on sexual functioning and marital satisfaction in Iran

OBJECTIVE

Sexual functioning is an important component of life quality and musculoskeletal disorders may effect sexual functioning, so, the present study was conducted to evaluate sexual functioning in patients suffering from back pain, rheumatoid arthritis, and systemic lupus erythematosus (SLE).

METHODS

This study was conducted on 102 patients with rheumatoid arthritis, 103 patients with back pain, 103 patients with SLE, and 210 people in the control group by the consecutive sampling method. The marital satisfaction questionnaire (Enrich), Arizona Sexual Experience Scale (ASEX) questionnaire, and the General Health Questionnaire (GHQ-28) were completed by all the subjects. Disease severity was determined in each group of patients by Disease Activity Score of 28 joints, the Roland Morris questionnaire, and the SLE Disease Activity Index questionnaire.

RESULTS

The GHQ in rheumatoid arthritis and lupus patients was meaningfully higher than the control group (P < .05), while there was no meaningful difference between back pain patients and the control group (P = .414). The sexual functioning questionnaire score in all 3 groups showed no statistically meaningful difference with the control group (P < .05). Also, the marital satisfaction questionnaire score in all the groups showed no statistically meaningful difference compared to the control group (P = .791).

CONCLUSION

The study has shown that the level of sexual function in participants with back pain and the level of mental health and sexual functioning in patients with rheumatoid arthritis and SLE are significantly lower than healthy people and there is a need for intervention for improving mental health as well as sexual functioning in these patients.

Sexual Health and Dysfunction in Patients With Rheumatoid Arthritis: A Cross-sectional Single-Center Study

Introduction

An increased risk of sexual health problems is seen among patients with chronic illnesses. The background is likely to be multifactorial, but it remains poorly understood.

Aim

To investigate the sexual health and functioning of patients with rheumatoid arthritis (RA) and to examine gender differences, general population comparisons, and possible somatic, psychological, and disease-specific determinants.

Methods

A cross-sectional study using a digital questionnaire distributed among 380 patients diagnosed with RA in a Danish university hospital outpatient setting.

Main Outcome Measure

A range of patient-reported outcomes were obtained, including scores from the validated rating scale Changes in Sexual Functioning Questionnaire. Furthermore, individual medical record information was collected.

Results

A total of 329 patients (250 women and 79 men) were included (age range: 25–73 years; mean age: 57.2 years). The Changes in Sexual Functioning Questionnaire scoring indicated an overall sexual dysfunction in 33.8% of men and 58.1% of women.More than one-third (37.6%) of patients felt that RA had made their sex life more complicated, and 32.4% feared that this might someday be the case. In total, 29.2% patients had experienced sexual problems due to their RA treatment. Of the respondents who experienced RA-related fatigue, 46.5% reported that this impacted negatively on their sexual activity. The risk of one or more sexual health adversities was significantly correlated with female gender, older age, moderate or severe depression, moderate to moderately high loneliness, more than 2 comorbidities, and a fatigue score above 75 out of 100 on a visual analogue scale. Compared to the general population, significantly fewer patients with RA considered their sex life important, and significantly fewer patients appraised their current sex life as good or very good. Moreover, significantly more women with RA (32.1%) than women from the general population (15.7%) had not had any sex life during the past year. A vast majority of patients with RA (93.5% of women and 85.5% of men) had not discussed sexual issues with a health-care professional during the last 5 years. Of all, 32.5% would like health-care professionals to address sexual topics in the consultation occasionally.

Conclusion

Sexual dysfunction is highly prevalent in patients with RA, but the problems are not regularly addressed in consultations provided by the rheumatology department.

Bay LT, Graugaard C, Nielsen DS, et al. Sexual Health and Dysfunction in Patients With Rheumatoid Arthritis: A Cross-sectional Single-Center Study. Sex Med 2020;8:615–630.

Experiences of sexual health in persons with hip and knee osteoarthritis: a qualitative study

Background

Osteoarthritis (OA) is the world’s most common form of arthritis and a common cause of musculoskeletal pain and disability. Persons living with chronic diseases often have affected sexual health because of pain and limited function. Osteoarthritis is a chronic disease but there is scarce knowledge about how sexual health is experienced. The aim of this study was to explore the experience of sexual health in persons who have seen a physiotherapist for their hip and/or knee OA.

Methods

This study has a qualitative design. Participants were recruited from the Swedish Quality Register Better Management of Patients with Osteoarthritis (BOA). To reach a variety of experiences and strengthen credibility, a purposeful sampling strategy based on age, sex and hip and knee OA was used. Semi-structured telephone interviews were held with 20 persons with hip and/or knee OA. Data were analysed with qualitative content analysis and inductive category development was applied.

Results

The analysis resulted in two main categories. The first category, Individual differences in how sexual health is affected by hip and knee OA, comprises of two sub categories: Pain limits sexual health; and Strategies for sexual health in the relationship. The second main category, Varying needs for communication about sexual health, is supported by the sub categories: Physiotherapists do not ask about sexual health; and Relevance of communicating about sexual health.

Conclusions

Painful hip and knee OA limit sexual health to varying degrees, and individuals make adjustments or develop strategies to maintain sexual life. Sexual health is not talked about during consultations with physiotherapists or other health care professionals, indicating that patients with OA may have unmet needs regarding their sexual health. Further research is needed on how to provide support and information about sexual health in OA.

Effect of 8-Week Aerobic Walking Program on Sexual Function in Women with Rheumatoid Arthritis

Introduction

Sexual dysfunction is a little-addressed condition in patients with rheumatoid arthritis. Aerobic exercises, including walking, can help alleviate this dysfunction. This study aimed to determine the effect of an 8-week aerobic walking program on sexual function ine patients with rheumatoid arthritis.

Methodology

This clinical trial was conducted on 51 patients with rheumatoid arthritis. At first, patients were selected through nonprobability sampling. They were then allocated into intervention and control groups using block randomization. The walking intervention was performed based on the frequency–intensity–time–type principle forg 8 consecutive weeks. Rosen’s Female Sexual Function Index was used for data collection before, immediately after, and 4 weeks after the intervention. Data collected were analyzed with SPSS 22 using descriptive and inferential statistics and 95% CI.

Findings

Mean sexual function scores before, after, and 4 weeks after intervention were 17.66±4, 22.88±4.7, and 24.39±5.1 in the intervention group and 17.60±4.24, 17.27±4.66, and 17.39±4.39 in the control group, respectively. Test results showed a significant intergroup difference in mean sexual function score (p<0.05).

Conclusion

Based on our results, an 8-week aerobic walking program is recommended as an effective way to improve sexual function in women with rheumatoid arthritis.

Prevalence of Sexual Disorders in Patients With Rheumatoid Arthritis and Associated Factors

Introduction

Rheumatoid arthritis (RA) is a chronic and progressive pathology, present in between 0.5% and 1% of adults. Sexual disorders (SDs) occur in between 31% and 70% of all patients with RA.

Aim

To establish the associated risk factors and the prevalence of SDs in a group of patients with RA.

Methods

An analytical cross-sectional study was performed, evaluated with the Diagnostic and Statistical Manual of Mental Disorders-V tool. The related factors and the activity of the disease were explored. A multivariate logistic regression analysis was conducted.

Main Outcome Measure

The prevalence of SDs was 29.6%. There was an association between the presence of SDs and gender (women; odds ratio [OR]: 0.6, 95% CI: 0.4–0.8), age (OR: 1.4, 95% CI: 1.1–1.8), psychological alterations (OR: 12.1, 95% CI: 5.9–27.2), and Disease Activity Score 28 (OR: 1.6, 95% CI: 1.2–2).

Results

A total of 1,436 patients, with a median age of 56 years, were analyzed.

Conclusion

SDs are present in a third of patients with RA. Among the factors associated with SDs were the activity of the disease, presence of mood disorders, psychiatric disorders, alcoholism, and concomitant autoimmune pathologies. These findings suggest the necessity of a multidisciplinary approach to properly manage RA, as well as an enhancement in communication channels between the health professional team and the patient.

Santos-Moreno P, Castro CA, Villarreal L, et al. Prevalence of Sexual Disorders in Patients With Rheumatoid Arthritis and Associated Factors. Sex Med 2020;8:510–516.

Systematic Review of the Impact of Inflammatory Arthritis on Intimate Relationships and Sexual Function

OBJECTIVE

To systematically review evidence of the impact of inflammatory arthritis on, or association of inflammatory arthritis with, intimate relationships and sexual function.

METHODS

Ovid Medline, Ovid PsycINFO, Ovid Embase, and EBSCO CINAHL databases were searched. Two independent reviewers selected articles, extracted data, and conducted manual searches of reference lists from included studies and previous reviews. The quality of evidence was assessed using standard risk-of-bias tools.

RESULTS

Fifty-five eligible studies were reviewed. Of these, 49 (89%) were quantitative, 5 (9.1%) were qualitative, and 1 (1.8%) used a mixed-method design. Few quantitative studies were rated as low risk of bias (n = 7 [14%]), many were rated as moderate (n = 37 [74%]) or high risk (n = 6 [12%]). Quantitative study sample sizes ranged from 10 to 1,272 participants, with a reported age range 32-63 years. Qualitative study sample sizes ranged from 8 to 57 participants, with a reported age range 20-69 years. In studies reporting the Female Sexual Function Index, all inflammatory arthritis groups demonstrated mean scores ≤26.55 (range of mean ± SD scores: 14.2 ± 7.8 to 25.7 ± 4.7), indicating sexual dysfunction. In studies reporting the International Index of Erectile Function, all inflammatory arthritis groups reported mean scores ≤25 (range of mean ± SD scores: 16.0 ± 5.3 to 23.8 ± 7.0), indicating erectile dysfunction. Key qualitative themes were impaired sexual function and compromised intimate relationships; prominent subthemes included inflammatory arthritis-related pain and fatigue, erectile dysfunction, diminished sexual desire, and sexual function fluctuations according to disease activity.

CONCLUSION

Sexual dysfunction appears highly prevalent among men and women with inflammatory arthritis, and increased clinician awareness of this impairment may guide provision of tailored education and support.

Sexual function and reproduction can be impaired in men with rheumatic diseases: A systematic review

BACKGROUND

Information about the possible effect of rheumatic diseases on male sexual function and reproduction (sexual health) is scarce and difficult to summarize. Factors known to impair sexual health, such as inflammation, medication use and hypogonadism can be present in a significant proportion of male patients with rheumatic diseases.

OBJECTIVES

The objective of our study was to systematically review the literature for the influence of paternal rheumatic disease on sexual health, such as sexual function, reproductive hormones, male fertility, pregnancy and offspring outcomes.

DATA SOURCES

English language articles identified through Embase, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Google Scholar and the Clinical trial registries of Europe and the USA published until February 2019.

STUDY APPRAISAL AND SYNTHESIS METHODS

Literature was synthesized in narrative form and in summary tables. Outcomes were categorized as: sexual function, reproductive hormones, fertility and pregnancy and offspring outcomes. Results are presented per category and per disease.

RESULTS

9735 articles were identified with our search strategy. After removal of duplicates, excluding articles by screening titles and abstracts and assessing eligibility by reading 289 fulltext articles, 87 articles fulfilled the eligibility criteria. All included studies enrolled patients diagnosed with a rheumatic disease and had results at least on one of the outcome categories. Sexual function was the most common category, followed by reproductive hormones, fertility and pregnancy and offspring outcomes. Sexual function is impaired in a high proportion of patients with rheumatic diseases. This was statistically significant in most of the studies where a control group was available. Clinically relevant abnormalities in reproductive hormones were mainly identified in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) and a positive correlation with disease activity were reported. Semen quality in men with rheumatic diseases can be impaired in patients with SLE, SpA, sarcoidosis, BD and MWS. Sperm count and motility were the most common semen quality parameters affected. No negative effect of paternal RA and vasculitis on pregnancy outcomes were reported in 3 studies. No studies reporting the effect of paternal disease on offspring outcomes were identified.

LIMITATIONS

Most of the studies included in this review suffer from an inconsistent methodological quality, definitions of outcomes varied in several studies, a wide variety of screening questionnaires and/or diagnostic tools were used and results might only apply to the specific populations that were studied.

CONCLUSIONS

This systematic review suggests that sexual health is impaired in men with rheumatic diseases. The degree and extent of sexual health impairment vary per disease. More research is needed to fully understand the link between rheumatic diseases and impaired male sexual health. Meanwhile, rheumatologists should be aware of this association and discuss it with their patients.

IMPLICATIONS OF KEY FINDINGS

Sexual health of men with rheumatic diseases can be impaired by the disease itself. Especially in men trying to conceive, information on sexual function, reproductive hormones and sperm quality are needed to identify these problems. Treatment resulting in lower disease activity can improve overall sexual health in man with rheumatic diseases and facilitate their journey to fatherhood.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO 2018 CRD42018099845.

Effects of Education About Rheumatoid Arthritis and Sexuality on the Sexual Problems of Women With Rheumatoid Arthritis

The present quasi-experimental study was conducted to determine the effects of education about rheumatoid arthritis (RA) and sexuality on the sexual problems of women with RA. The study included 103 women with RA (51 in the experimental group, 52 in the control group). The study data were collected using the Personal Information Form and Female Sexual Function Index (FSFI). The women in the experimental group were provided education on sexuality, while those in the control group received no intervention. The aforementioned scales were administered twice: during the recruitment visit and then 1 month after the intervention. In the second measurement, the mean FSFI score increased in the experimental group, but was low in the control group, with the differences between the two groups being significant. Thus, providing sexual education to women with RA was effective in reducing sexual problems in women.

Medicinal plants of the Caatinga, northeastern Brazil: Ethnopharmacopeia (1980-1990) of the late professor Francisco José de Abreu Matos

ETHNOPHARMACOLOGICAL IMPORTANCE

The Caatinga (semi-arid region), is an exclusively Brazilian biome. Considering the scarcity of ethnobotanical and ethnopharmacological studies in this region before the year 2000, this study presents data from ethnobotanical expeditions carried out between 1980 and 1990, by the late professor Francisco José de Abreu Matos (1924-2008). The information revealed in this present work are valuable and remained unpublished until now.

MATERIALS AND METHODS

The objective was to organize, systematize and analyze ethnobotanical and ethnopharmacological data using ethnobotanical analytical techniques. The most cited native species in each use category were selected for literature review of the pharmacological studies related to their ethnomedicinal uses.

RESULTS

Revision of the botanical nomenclature led to the botanical confirmation of 272 plants, of which 84 (30.9%) were reclassified. These represented 71 families and 220 genera that were cited 1957 times. 153 (56.3%) of these plant species are native to Brazil, of which 36 (23.4%) are endemic to the Caatinga. The use reports (RU) associated with these plants, according to the body systems (ICPC-2) in decreasing order of UR and the ICF values were respiratory system (93 species, 407 UR, ICF 0.77), digestive system (119 species, 373 UR, ICF 0.68), general and nonspecific symptoms (95 species, 219 UR, ICF 0.58), female genital system (60 species, 184 UR, ICF 0.68), skin (71 species, 156 UR, ICF 0.55), cardiovascular (50 species, 99 UR, ICF 0.50), blood and immune system diseases (46 species, 96 UR, ICF 0.53), urological (44 species, 88 UR, ICF 0.51), musculoskeletal (33 species, 80 UR, ICF 0.60), psychological (21 species, 71 UR, ICF 0.60), while others represent less than 10.0% of the UR. The most cited plants in the disease categories were Dysphania ambrosioides (28), Pombalia calceolaria (28) Hymenaea courbaril (26), Myracrodruon urundeuva (50), Brassica juncea subsp. integrifolia (16), Scoparia dulcis (22), Phyllanthus niruri (14), Egletes viscosa (25), Lippia alba (16), Erythroxylum vacciniifolium (9) and Salvia rosmarinus (21). The most prominent clades of the medicinal plants based on cluster analysis were the Lamiids (Euasterids)-497 UR and the Fabids (Eurosids I) - 468 UR. Association between certain phylogenetic clades and use-category were also observed and discussed.

CONCLUSION

This study demonstrated a new approach in ethnopharmacology by mapping plant usages to diseases prevalent in a community from old ethnobotanical travel reports. In addition to revealing the therapeutic potential of Caatinga species using cluster analysis.

High Burden of Sexual Dysfunction in Female Patients with Rheumatoid Arthritis: Results of a Cross-sectional Study

Objective.

To evaluate the effect of rheumatoid arthritis (RA) on impairing women’s sexuality regarding motivation, activity, and satisfaction, and to assess the correlation of disease-related physical impairment within sexual functioning.

Methods.

An anonymous survey among women with RA and healthy controls (HC) using standardized questionnaires, predominantly the Changes in Sexual Functioning Questionnaire-short form (CSFQ-14). In addition, disease activity, depression, and disability were evaluated.

Results.

There were 319 questionnaires distributed to patients and 306 to HC. Of these, 235 patient questionnaires (73.7%) and 180 HC questionnaires (58.8%) were returned, of which 203 and 169 were completed, respectively. Of the patients with RA, 47.8% had a total CSFQ-14 score of ≤ 41, indicating female sexual dysfunction (FSD), as compared to 14.2% of HC (p < 0.0001). The median CSFQ-14 score was lower in patients with RA [42 points, interquartile range (IQR) 36–48] than in HC (49 points, IQR 44–54; p < 0.0001), resulting in an OR of 5.53 (95% CI 3.19–9.57; p < 0.0001). After adjustment for confounders, given a higher mean age of patients (55.2 ± 11.3 yrs) than HC (47.4 ± 11.8 yrs; p < 0.0001), the OR for FSD in patients with RA was still 3.04 (95% CI 1.61–5.75; p = 0.001). Neither the Health Assessment Questionnaire–Disability Index nor the Clinical Disease Activity Index was associated with FSD after adjustment.

Conclusion.

FSD apparently is highly prevalent in female patients with RA, affects all subdomains of sexual function, and is most likely underestimated in daily clinical practice. Of note, FSD could not be linked to disability or RA disease activity.

Rheumatoid Arthritis and Risk of Sexual Dysfunction: A Systematic Review and Metaanalysis

Objective.

It has been reported that there is an association between rheumatoid arthritis (RA) and increased susceptibility to sexual dysfunction (SD). This systematic review and metaanalysis aimed to investigate whether RA was a risk factor for SD.

Methods.

MEDLINE (PubMed), EMBASE, and the Cochrane Library were systematically searched for all studies assessing sexual function in patients with RA. The association between RA and risk of SD was summarized using relative risk (RR) with 95% CI.

Results.

Overall, 44,745 participants (mean age 43.2 yrs) were included from 7 studies (4 cross-sectional and 3 case-control studies). Of these, 6642 were patients with RA, with the mean disease duration from 5.7 years to 12.17 years. The methodological qualities of the included studies were judged as moderate to high. Synthesis of results demonstrated that RA was significantly associated with an increased risk of SD in females (RR 1.73, 95% CI 1.36–2.22, p < 0.001; heterogeneity: I2 60.3%, p = 0.028) as well as in males (RR 1.99, 95% CI 1.64–2.43, p < 0.001). The outcomes related to the Grading of Recommendations Assessment, Development, and Evaluation approach showed that the absolute effect of RA on SD was 10 more per 1000 (6–15 more); the overall quality of evidence was rated as low.

Conclusion.

Evidence from included studies indicates that patients with RA have a significantly increased risk of SD, which suggests that both patients and clinicians should be aware of the potential role of RA in the development of SD.

Sexual health in patients with rheumatoid arthritis and the association between physical fitness and sexual function: a cross-sectional study

The aim of this study was to examine sexual health in patients with rheumatoid arthritis (RA), and to analyse factors associated with sexual health with a focus on physical fitness. One hundred RA patients aged between 18 and 65 years were included in a cross-sectional study. Handgrip strength and knee extensor strength were measured with a dynamometer, and physical performance with the Short Physical Performance Battery (SPPB). Fifty-four patients, mean age 47.8 (SD 10.6) years, 61% female, answered a questionnaire about sexual health. Fifty-seven percent reported, at least, sometimes having difficulty with sexual intercourse (27.8% due to joint stiffness, 24.1% due to fatigue, 18.5% due to pain). Handgrip strength and knee extensor strength significantly correlated with the desire to engage in sexual intercourse, frequency of sexual contact and satisfaction with overall sex life. The SPPB total score correlated with satisfaction with overall sex life, and the SPPB repeated chair stands test with the desire to have sexual intercourse and satisfaction with overall sex life. After adjusting for age, gender, disease activity, comorbidity, co-medication and pain intensity, the repeated chair stands test remained significantly associated with the frequency of sexual contact (0.53; 0.01–1.05) and with satisfaction with overall sex life (1.39; 0.28–2.51). The results of this study show that problems with sexual health are highly prevalent in patients with RA. The ability to rise from a chair is associated with sexual function, independent of disease activity and pain intensity.

The importance of physiotherapy in the sexuality of patients with rheumatic diseases

The sexuality of patients with rheumatic diseases is a significant interdisciplinary problem, requiring intensified action not only of rheumatologists, sexologists, and psychologists but also physiotherapists. The sexuality problems and motor disability in chronic diseases such as rheumatoid arthritis or ankylosing spondylitis, as well as other rheumatic diseases, are generally still taboo subjects, rarely discussed by physicians and physiotherapists. Lack of mobility, hormonal imbalance, fatigue, and accompanying decreased quality of life have an impact on sexual dysfunction. Meanwhile sex, as an integral part of human personality, is an essential element of human life.

Factors associated with sexual dysfunction in Taiwanese females with rheumatoid arthritis

Background

Patients with rheumatoid arthritis (RA) may experience sexual dysfunction because of symptoms or adverse effects from treatments. Data on female sexual dysfunction (FSD) in Asian females with RA issue are limited. This study investigated the prevalence and factors associated with FSD in Taiwanese patients with RA.

Methods

This cross-sectional study used a purposive sampling method to recruit 195 females with RA from a single hospital in southern Taiwan. Demographic and clinical characteristics were obtained by review of medical records and a structured questionnaire. The Chinese version of the Female Sexual Function Index and the Taiwanese Depression Questionnaire were also administered. Multiple logistic regression analysis was used to identify factors associated with FSD.

Results

The crude and age-standardized prevalence of FSD were 66.8% and 48.2%, respectively. Patients who were older, with a comorbid condition, with more depressive symptoms, and with greater disease activity had a significantly higher risk of FSD.

Conclusion

Our findings indicate that FSD is more common in Taiwanese individuals with RA who have certain specific demographic and clinical characteristics. These findings may help to identify and facilitate the provision of appropriate interventions to ensure better sexual health in female patients with RA.

Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations

In the World Health Organization's forthcoming eleventh revision of the International Classification of Diseases and Related Health Problems (ICD-11), substantial changes have been proposed to the ICD-10 classification of mental and behavioural disorders related to sexuality and gender identity. These concern the following ICD-10 disorder groupings: F52 Sexual dysfunctions, not caused by organic disorder or disease; F64 Gender identity disorders; F65 Disorders of sexual preference; and F66 Psychological and behavioural disorders associated with sexual development and orientation. Changes have been proposed based on advances in research and clinical practice, and major shifts in social attitudes and in relevant policies, laws, and human rights standards. This paper describes the main recommended changes, the rationale and evidence considered, and important differences from the DSM-5. An integrated classification of sexual dysfunctions has been proposed for a new chapter on Conditions Related to Sexual Health, overcoming the mind/body separation that is inherent in ICD-10. Gender identity disorders in ICD-10 have been reconceptualized as Gender incongruence, and also proposed to be moved to the new chapter on sexual health. The proposed classification of Paraphilic disorders distinguishes between conditions that are relevant to public health and clinical psychopathology and those that merely reflect private behaviour. ICD-10 categories related to sexual orientation have been recommended for deletion from the ICD-11.

Sexual dysfunction and its determinants in Moroccan women with rheumatoid arthritis

INTRODUCTION

To assess the prevalence of sexual dysfunction in married women with rheumatoid arthritis (RA) and compare it with a control group and to determine its association with clinical and disease activity factors.

METHODS

We conducted a cross-sectional study including sixty married women with a confirmed diagnosis of Rheumatoid Arthritis according to the American College of Rheumatology (ACR)/ European League against Rheumatism (EULAR) 2010 Criteria, aged 18 or over and having sexual activity. Our controls were healthy volunteers women matched for age. Clinical and sociodemographic characteristics were collected. Sexual function was assessed by a self-reported questionnaire the index of female sexual function (FSFI). Sociodemographic and disease activity profiles were compared between those who had and did not have sexual dysfunction.

RESULTS

The prevalence of female sexual dysfunction in women with rheumatoid arthritis attending El Ayachi hospital was 71.9%, it was 54% in controls. There was a significant difference in the total FSFI score between patients 18.29±9.09 and controls 23.05±7.91 (p=0.016). We found a statistically significant difference between the two groups in almost all dimensions of sexual function (desire, arousal, orgasm, satisfaction), except for pain and lubrication. In multivariate analysis, pain assessed by visual analogue scale (VAS) and depression assessed by hospital anxiety and depression score (HAD) were the independent determinants of sexual dysfunction.

CONCLUSION

Our study suggests that sexual dysfunction is more common among patients with RA compared to controls. These dysfunctions were related to desire, arousal, orgasm and satisfaction. Pain and depression appear to be the most important predictors of sexual dysfunction.

A structured literature review of the burden of illness and unmet needs in patients with rheumatoid arthritis: a current perspective

While rheumatologists often focus on treatment targets, for many patients with rheumatoid arthritis (RA), control over pain and fatigue, as well as sustaining physical function and quality of life (QoL), is of primary importance. This literature review aimed at examining patients' and physicians' treatment aspirations, and identifying the unmet needs for patients with RA receiving ongoing treatment. Searches were performed using MEDLINE, Embase, PsycINFO, and Econlit literature databases for articles published from 2004 to 2014 in the English language. Published literature was screened to identify articles reporting the unmet needs in RA. We found that, despite the wide range of available treatments, RA continues to pose a substantial humanistic and economic burden on patients, and there are still unmet needs across key domains such as pain, physical function, mental function, and fatigue. These findings suggest that there is a need for further treatment advances in RA that address these domains of contemporary unmet need.

Sexual Self-Concept and General Health in Rheumatoid Arthritis Patients

Background:

There are several studies regarding sexual dysfunction in chronic diseases such as diabetes and renal failure; however, no significant study has been done on Iranian rheumatoid arthritis (RA) patients.

Objectives:

In this study, we aimed to identify and compare sexual dysfunction between RA patients and the normal population.

Patients and Methods:

In this case-control study, two groups of females (87 RA patients and 89 controls) were randomly selected from the rheumatology clinic of Baqiyatallah Hospital, Tehran, Iran. General health questionnaire (GHQ-28) and multidimensional sexual self-concept questionnaire (MSSCQ) were used to evaluate RA patients. We used SPSS for statistical analysis mainly by the t-test and chi-square test. P values less than 0.05 were considered significant.

Results:

In the GHQ-28 evaluation, RA patients had lower social function; however somatization rated higher in normal patients (P < 0.05). Sexual health was lower in the RA population (P < 0.05). No significant difference was found in sexual desire. Except sexual pain, other sexual health parameters were lower in RA patients. The scores were as follow: sensation 13.6 ± 4.4 vs. 12.2 ± 4.5, P = 0.024; lubrication 6.9 ± 2.1 vs. 6.2 ± 2.1, P = 0.017; orgasm 10.4 ± 2.8 vs. 9.5 ± 3.2, P = 0.37; pain 10.1 ± 2.2 vs. 10.8 ± 1.9, P = 0.013; enjoyment 23.8 ± 5.8 vs. 21.3 ± 7.5, P = 0.009 and partner related 8.5 ± 1.7 vs. 7.6 ± 2.4, P = 0.005. Furthermore, the concern of losing their sexual partner was higher in the normal population.

Conclusions:

Our study demonstrated that almost all GHQ and MSSCQ parameters were lower in RA patients, which indicates lower quality sexual life in RA patients. We recommend further consideration for the treatment and care of these patients.

The motherhood choices decision aid for women with rheumatoid arthritis increases knowledge and reduces decisional conflict: a randomized controlled trial

BACKGROUND

For many women with Rheumatoid Arthritis (RA) motherhood decisions are complicated by their condition and complex pharmacological treatments. Decisions about having children or expanding their family require relevant knowledge and consultation with their family and physician as conception and pregnancy has to be managed within the RA context. Relevant information is not readily available to women with RA. Therefore a randomized controlled study was conducted to evaluate the effectiveness of a new motherhood decision aid (DA) developed specifically for women with RA.

METHODS

One hundred and forty-four women were randomly allocated to either an intervention or control group. All women completed a battery of questionnaires at pre-intervention, including, the Pregnancy in Rheumatoid Arthritis Questionnaire (PiRAQ), the Decisional Conflict Scale (DCS), the Hospital Anxiety and Depression Scale (HADS), and the Arthritis Self-Efficacy Scale (ASES), and provided basic demographic information. Women in the DA group were sent an electronic version of the DA, and completed the battery of questionnaires for a second time post-intervention.

RESULTS

Women who received the DA had a 13 % increase in relevant knowledge (PiRAQ) scores and a 15 % decrease in scores on the decisional conflict (DCS), compared to the control group (1 %, 2 % respectively). No adverse psychological effects were detected as evident in unchanged levels of depression and anxiety symptoms.

CONCLUSIONS

The findings of this study suggest that this DA may be an effective tool in assisting women with RA when contemplating having children or more children.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry, http://www.anzctr.org.au/ , ACTRN12615000523505.

Fatigue in Egyptian patients with rheumatic diseases: a qualitative study

OBJECTIVES

Fatigue is frequent in rheumatic diseases. Fatigue expression and consequences may be modified by cultural differences. Our objective was to increase the understanding of the fatigue experience and characteristics among Egyptian, Muslim patients with rheumatic diseases.

METHODS

Prospective monocentric qualitative study based on conventional qualitative content analysis, inductive reasoning, grounded theory. Egyptian patients with rheumatoid arthritis (RA), fibromyalgia or axial spondyloarthritis (AxSpA) were asked about fatigue, its patterns, consequences and self-management.

RESULTS

Of the 60 patients interviewed, 20 patients had each disease (RA, fibromyalgia and AxSpA); median ages ranged from 34 to 40 years. Patients were mainly male (N = 40, 66%), had 3 to 7 years (mean) of disease duration and had moderate disease activity. Some aspects of the patients' experience of fatigue may be specific to the Egyptian and Muslim culture such as the description of fatigue as a physical more than a mental impact of the disease, the response to the effect of fatigue on sexual function and the gender specific (women more than men) limitation of social activities due to fatigue which was more obvious in our study than other previous studies. Other aspects of patients' experience of fatigue like overlap between the patients' perception of fatigue and pain and coping strategies were similar to the findings in previous studies.

CONCLUSION

This study gives insights regarding fatigue in rheumatic diseases in an Arabic and Muslim culture. Similarities and differences with previous studies were noted and should be taken into account when assessing these patients.

Quality of Sexual Life in Women with Primary Sjögren Syndrome

Objective.

To assess the quality of sexual life of women with primary Sjögren syndrome (pSS) and to identify its correlations with disease activity and damage, quality of life, and mood disorders.

Methods.

The quality of sexual life of 24 women with pSS was assessed with the Female Sexual Function Index (FSFI). Twenty-four healthy women, matched by age and hormonal status, were enrolled as controls. Mood disorders and quality of life were investigated using the Hospital Anxiety and Depression Scale (HADS) and the Medical Outcomes Study Short Form-36. Patients underwent a gynecological visit with vaginal pH measurement, cervicovaginal swabs, and Pap smears. Disease activity and damage were assessed by the European League Against Rheumatism Sjögren syndrome disease activity and damage indexes.

Results.

Patients with pSS showed a pathological mean FSFI score (19.1 ± 7.33) significantly different from controls (p = 0.004), both in menstruating women (p = 0.006) and in menopausal women (p = 0.03). Major differences between the 2 groups were detected in dyspareunia (p < 0.005), lubrication (p = 0.006), desire (p = 0.004), and arousal (p = 0.018). The FSFI score was inversely correlated with age (p = 0.008) and anxiety HADS (p = 0.031). No early anatomical changes, swabs, and Pap smear alterations were revealed in patients with pSS; however, vaginal pH was higher than normal in premenopausal patients (6.0 ± 0.77).

Conclusion.

Both premenopausal and postmenopausal women with pSS have a worse sexual quality of life. We reported a greater prevalence of dyspareunia that is statistically significant when compared with controls. The FSFI could be a useful tool to assess this topic, but has been neglected in the care of patients with pSS heretofore.

Prevalence of sexual dysfunction among female patients followed in a Brasília Cohort of early rheumatoid arthritis

OBJECTIVE

To determine the prevalence of sexual dysfunction in women diagnosed with early rheumatoid arthritis (RA) (less than one year of symptoms at the time of diagnosis), as well as to evaluate the possible association between sexual dysfunction with AR activity and functional disability.

METHODS

Cross-sectional study assessing women diagnosed with early RA, accompanied per protocol in the Brasilia Cohort, Hospital Universitário de Brasília. Demographics, disease activity index (Disease Activity Score 28 - DAS 28) and functional disability questionnaire (Health Assessment Questionnaire - HAQ), were obtained by direct interviews. The Female Sexual Function Index (FSFI) was used, questionnaire which contains 19 items that assess six domains: sexual desire, sexual arousal, vaginal lubrication, orgasm, sexual satisfaction and pain.

RESULTS

68 patients studied, of whom 54 (79.4%) reported sexual activity in the last four weeks. The participants were 49.7±13.7 (mean±SD) years old and the majority were married (61.4%). The mean DAS 28 was 3.6±1.5 and the mean HAQ was 0.7. The prevalence of sexual dysfunction (FSFI ≤26) was 79.6%. There was no association of disease activity or of functional disability with the occurrence of sexual dysfunction in the female patients evaluated.

CONCLUSION

The prevalence of sexual dysfunction found in this study was higher than that reported in the literature in healthy women. A knowledge of the extent of the problem is needed to provide adequate therapeutic options for these patients.