Erectile dysfunction is frequent in systemic sclerosis and associated with severe disease: a study of the EULAR Scleroderma Trial and Research group

Abstract

IntroductionErectile dysfunction (ED) is common in men with systemic sclerosis (SSc) but the demographics, risk factors and treatment coverage for ED are not well known.MethodThis 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.ResultsOf 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.ConclusionsSevere 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.

Psychosocial Aspects of Scleroderma

“…[45][46][47] Most men with SSc who have ED do not receive treatment. 45 Among those who do, sildenafil seems to be commonly used, but its efficacy has not been established in SSc. 44,45 …”

“…46 Men with SSc who have ED are significantly more likely to be older than those without ED and tend to report non-SSc risk factors (eg, alcohol consumption) at higher rates. 45,46 SSc factors associated with ED include severe cutaneous, muscular, or renal involvement; diffuse disease; increased pulmonary pressures; restrictive lung disease;, endothelial dysfunction; and microvascular damage. [45][46][47] Most men with SSc who have ED do not receive treatment.…”

“…45,46 SSc factors associated with ED include severe cutaneous, muscular, or renal involvement; diffuse disease; increased pulmonary pressures; restrictive lung disease;, endothelial dysfunction; and microvascular damage. [45][46][47] Most men with SSc who have ED do not receive treatment. 45 Among those who do, sildenafil seems to be commonly used, but its efficacy has not been established in SSc.…”

“…41 Among men with SSc, erectile dysfunction (ED) is common with onset typically occurring several years after the manifestation of the first non-Raynaud symptoms. [44][45][46] In the general population, ED is typically associated with atherosclerosis, but in SSc penile blood flow is impaired because of both myointimal proliferation of small arteries and corporal fibrosis. 46 Men with SSc who have ED are significantly more likely to be older than those without ED and tend to report non-SSc risk factors (eg, alcohol consumption) at higher rates.…”

“…45 Among those who do, sildenafil seems to be commonly used, but its efficacy has not been established in SSc. 44,45 …”