Association between ED in ankylosing spondylitis: a population-based study

Erectile dysfunction in ankylosing spondylitis: a systematic review and meta-analysis

Background

The prevalence of erectile dysfunction (ED) in ankylosing spondylitis (AS) patients was reported rarely and with small sample.

Aim

The study sought to explore the prevalence of ED in men with AS and to determine whether AS is a risk factor for ED.

Methods

A systematic search was conducted in the China National Knowledge Infrastructure, Wanfang, VIP Database, CBM, PubMed, Web of Science, and Cochrane Library. The search was restricted to the articles published up to October 2022. Assessment tools adapted for prevalence studies were used to evaluate the quality of cross-sectional studies, and the quality of case-control studies was assessed by Newcastle-Ottawa scale. The relative risk (RR) and the standard mean difference (SMD) were used to evaluate the association between AS and ED. The subgroup analyses were conducted to identify the resources of heterogeneity. The sensitivity analysis was performed to assess the stability of the pooled estimates. Data were analyzed and graphed using STATA 16.0.

Outcomes

The pooled prevalence of ED in AS patients was calculated and the RR and the SMD were used to evaluate the association between AS and ED.

Results

A total of 393 AS patients, enrolled in the 8 included studies, were assessed for the prevalence of ED. The pooled ED prevalence estimate was 44% (95% confidence interval [CI], 25% to 63%, P < .001) with the statistical heterogeneity (I² = 95.1%, P < .001). After pooling the data for RR, the results showed that men with AS were at a significantly higher risk for ED when compared with the general population without AS (RR, 2.04; 95% CI, 1.28 to 3.25, P = .003; heterogeneity: I² = 72.6%, P = .003). The pooled results of 5 studies, which provided the International Index of Erectile Function (IIEF) score, demonstrated that patients with AS had significantly lower values in the IIEF erectile function domain as compared with the healthy control subjects (SMD, -0.60; 95% CI, -0.80 to -0.41; P < .001; heterogeneity: I² = 34.4%, P = .192). Additionally, the other domain of the IIEF also showed lower values when compared with the general population without AS (P < .05).

Clinical Implications

The present meta-analysis provides evidence of the management of ED in men with AS.

Strengths and Limitations

This is the first meta-analysis to provide the prevalence of ED in AS patients and to demonstrate that AS is a risk factor for ED. However, the results after pooling the included studies showed significant heterogeneity.

Conclusion

Our meta-analysis demonstrated the high prevalence of ED in men with AS and that AS is a potential risk factor for ED.

Association between coronary heart disease and erectile dysfunction in Chinese Han population

To investigate the association between coronary heart disease (CHD) and erectile dysfunction (ED) in Chinese Han population. Patients who went to the andrological out-patient clinic of our hospital between August 1, 2015 and May 1, 2016 and met all eligible criteria were enrolled in this study. The patients diagnosed as ED using self-administered International Index of Erectile Function-5 (IIEF-5) questionnaire were considered as case group and others were considered as control. The cases were categorized as mild, moderate, and severe ED. Subjects were interviewed for the history of CHD. Uni- and multivariate logistic regression models were used to calculate odds ratios (ORs) and corresponding 95% confidence intervals (CIs) using the SPSS 18.0 software. A total of 240 participants (56 ED patients and 184 controls) were enrolled. CHD prevalence was higher in cases without statistical significance (OR = 1.20, 95%CI = 0.63-2.29; p = 0.58). Results of adjusted analysis also showed a non-significantly increased risk (OR = 1.25, 95%CI = 0.55-2.85; p = 0.59). Stratified analysis by severity of ED revealed similar results. This study suggests no significant association exists between CHD and ED in Chinese Han population.

Impact of ankylosing spondylitis on sexual function: A systematic review and meta-analysis

A number of studies have reported the association of sexual problems with ankylosing spondylitis (AS); however, the results have been conflicting. The present study aimed to investigate the impact of AS on sexual function. To develop a more comprehensive understanding of sexual function in patients with AS, a systematic review and meta-analysis of the literature up to 2013 was conducted. Studies that assessed the impact of AS on sexual function by adopting the International Index of Erectile Function or the Female Sexual Function Index (FSFI) scoring system were included. Statistical analysis was performed using Review Manager statistical software (version 5.2). The weighted mean differences were calculated by employing a fixed or random effects model. A total of 484 cases from five studies were identified as being well-documented and included in the meta-analysis. Compared with healthy controls, male patients with AS have a significant reduction in sexual function scores of erectile function (−3.07), orgasmic function (−1.17), sexual drive (−0.72) and intercourse satisfaction (−1.89). Female patients with AS have a lower FSFI score in domains of desire (−0.34) and arousal (−0.87). In conclusion, AS has a certain impact on the sexual function of male patients. AS appears to have a greater influence on the sexual function of males compared with that of females. However, the mechanism by which AS affects sexual function requires further evaluation by further studies of a larger population of patients.

Genetic variations in the KIR gene family may contribute to susceptibility to ankylosing spondylitis: a meta-analysis

The present meta-analysis of relevant case-control studies was conducted to investigate the possible relationships between genetic variations in the killer cell immunoglobulin-like receptor (KIR) gene clusters of the human KIR gene family and susceptibility to ankylosing spondylitis (AS). The following electronic databases were searched for relevant articles without language restrictions: the Web of Science, the Cochrane Library Database, PubMed, EMBASE, CINAHL, the Chinese Biomedical Database (CBM) and Chinese National Knowledge Infrastructure (CNKI) databases, covering all papers published until 2013. STATA statistical software was adopted in this meta-analysis as well. We also calculated the crude odds ratios (OR) and its 95% confidence intervals (95 % CI). Seven case-control studies with 1,004 patients diagnosed with AS and 2,138 healthy cases were implicated in our meta-analysis, and 15 genes in the KIR gene family were also evaluated. The results of our meta-analysis show statistical significance between the genetic variations in the KIR2DL1, KIR2DS4, KIR2DS5 and KIR3DS1 genes and an increased susceptibility to AS (KIR2DL1: OR 7.82, 95% CI 3.87-15.81, P< 0.001; KIR2DS4: OR 1.91, 95% CI 1.16-3.13, P = 0.010; KIR2DS5: OR1.51, 95% CI 1.14-2.01, P = 0.004; KIR3DS1: OR 1.58, 95% CI 1.34-1.86, P< 0.001; respectively). However, we failed to found positive correlations between other genes and susceptibility to AS (all P >0.05). The current meta-analysis provides reliable evidence that genetic variations in the KIR gene family may contribute to susceptibility to AS, especially for the KIR2DL1, KIR2DS4, KIR2DS5 and KIR3DS1 genes.