Background Although systemic lupus erythematosus (SLE) has a higher prevalence in women, the disease usually has a more aggressive course in men. Information regarding erectile function in men with SLE is quite scant.
Objectives The aim of this study was to describe the prevalence of erectile dysfunction (ED), as well as associated demographic and clinical features, in men with SLE, by means of a systematic, standardized evaluation.
Methods We performed a transversal study in eight tertiary care centers in Latin America. We included male patients ≥16 years who fulfilled ≥4 ACR criteria for SLE, and who had regular sexual activity in the previous 6 months. Patients with other rheumatic diseases (except for APS), chronic viral infections and late-onset SLE were excluded. All patients answered the IIEF-5 Questionnaire, which has been validated in Spanish. Other relevant demographic, clinical and serological characteristics were documented. We included two control groups: the first one was made up by healthy men and the second by men with autoimmune diseases different from SLE (non-SLE group).
Results We included 279 subjects (174 SLE, 55 non-SLE and 50 healthy controls). The prevalence of ED in SLE group 68% (vs 22% in healthy group, p=0.001). The mean age of patients with ED in the SLE group was 36.1±1.03, while in patients without ED it was 32.5±1.27 (p=0.022). Whereas there was no difference regarding ED prevalence between SLE patients and the non-SLE group (68 vs 60%, p=0.25), patients with other autoimmune diseases were 10 years older (46.3±1.60 years, p=0.001).
Among SLE patients with and without ED, the presence of persistent lymphopenia (≤1000cells/mcl at three consecutive times, p=0.006), the prednisone dose (9.3±1.2 vs 5.3±1.2mg, p=0.026), as well as the SLICC damage score (1.2±0.1 vs 0.8±0.1 points, p=0.026), were significantly different. Comorbidities and other demographic, serological and treatment variables were not different between those groups. Multivariate analysis showed the following independent risk factors for ED in SLE patients: persistent lymphopenia (OR 2.79 CI95% [2.79–5.70], p=0.001) and corticosteroid use (any dose) in the previous year (OR 2.15 CI95% [1.37–3.37], p=0.001). Only 7% of patients had been questioned about their sexual function in the previous three visits to the rheumatologist; also, 81% of subjects considered it would be appropriate to be asked about their sexual function.
Conclusions Regardless of comorbidities, treatment (excluding steroids) and type of disease activity, SLE patients have a high prevalence of ED, especially considering most patients are young and sexually active. Rheumatologists should be aware of the relevance of this problem in male SLE patients and should ask about this issues in regular visits.
Disclosure of Interest None declared