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Erectile dysfunction is frequent in systemic sclerosis and associated with severe disease: a study of the EULAR Scleroderma Trial and Research group
Authors:Chingching Foocharoen  Alan Tyndall  Eric Hachulla  Edoardo Rosato  Yannick Allanore  Dominique Farge-Bancel  Paola Caramaschi  Paolo Airó  Starovojtova M Nikolaevna  José António Pereira da Silva  Bojana Stamenkovic  Gabriela Riemekasten  Simona Rednic  Jean Sibilia  Piotr Wiland  Ingo Tarner  Vanessa Smith  Anna T Onken  Walid Ahmed Abdel Atty Mohamed  Oliver Distler  Jadranka Morović-Vergles  Andrea Himsel  Paloma Garcia de la Peña Lefebvre  Thomas Hügle  Ulrich A Walker
Affiliation:1. Department of Rheumatology, Basel University, Burgfelderstrasse 101, Basel, 4012, Switzerland
2. Department of Internal Medicine, H?pital 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, H?pital 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, Schumannstra?e 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, Benekestra?e 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 Stra?e 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. ?u?ka 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/O?A N° 10, Madrid, 28050, Spain
Abstract:

Introduction

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.

Method

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.

Results

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.

Conclusions

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.
Keywords:
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