Sexual problems in men with ankylosing spondylitis tied to disease activity

Male patients with ankylosing spondylitis (AS) appear to have poor sexual performance, and this problem is associated with disease activity rather than sexual hormonal profile, according to a study.

The analysis included 35 male AS patients and 104 healthy controls. All of them completed the International Index of Erectile Function (IIEF) questionnaire. They also had their total testosterone (TT), free testosterone (FT), bioavailable testosterone (BT), serum hormone binding globulin (SHBG), albumin, and luteinizing hormone (LH) concentrations measured.

Results for the IIEF were worse in AS patients than in controls (p=0.02). Moreover, the former had significantly higher levels of total testosterone (p=0.01) and SHBG (p<0.0001). There were no significant between-group differences seen in LH, FT, and BT levels.

On further analysis, the IIEF score in the AS group showed no correlation with TT, SHBG, LH, FT, and BT. Instead, it was negatively associated with disease activity, as measured with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI; p=0.001) and Ankylosing Spondylitis Disease Activity Score C-reactive protein (ASDAS-CRP; p=0.02).

The pathogenesis of sexual problems in patients with AS is said to be complicated and multifactorial. Mechanisms underlying the association involve TNF-α concentrations, which are elevated in the circulation and synovial tissue in AS patients and acts as a potential candidate in the pathophysiology of ED. Joint pain, increased disease activity, decreased functionality, declined health quality, and depression may also play a role. [Exp Ther Med 2015;9:1501-1507]