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Heřmánková B, Oreská S, Špiritović M, Štorkánová H, Komarc M, Pavelka K, Šenolt L, Vencovský J, Bečvář R, Tomčík M. Sexual function and pelvic floor function in men with systemic sclerosis compared to healthy controls: a cross-sectional study. Aging Male 2024; 27:2336630. [PMID: 38584363 DOI: 10.1080/13685538.2024.2336630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/26/2024] [Indexed: 04/09/2024] Open
Abstract
OBJECTIVES This cross-sectional study aimed to compare the sexual function (SF) and pelvic floor function of men with systemic sclerosis (SSc) with age-matched healthy controls (HC) and to identify the implications of clinical features on SF. MATERIAL AND METHOD Twenty SSc males and 20 HC aged 18-70 years completed eleven questionnaires assessing SF [International Index of Erectile Function (IIEF), Male Sexual Health Questionnaire (MSHQ)]; sexual quality of life: Sexual Quality of Life Questionnaire-Male (SQoL-M); pelvic floor function: Pelvic Floor Impact Questionnaire-Short Form 7 (PFIQ-7), fatigue, depression, physical fitness, functional disability, and quality of life. Clinical data were collected. RESULTS Significantly worse SF was observed in patients (median IIEF erectile function 12 in SSc versus 29 in HC, p < 0.001), with 70% reporting erectile dysfunction (ED) compared to 15% in HC. However, no significant difference was observed regarding pelvic floor function (median PFIQ7 8.8 in SSc versus 7.0 in HC, p = 0.141). Impaired SF was associated with higher disease activity, increased systemic inflammation, more pronounced fatigue, reduced physical fitness, severe depression, impaired overall quality of life, dyspepsia, and arthralgias (p < 0.05 for all). CONCLUSIONS Sexual dysfunction is highly prevalent in our SSc patients, whereas pelvic floor dysfunction is unlikely to be associated with these problems.
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Affiliation(s)
- Barbora Heřmánková
- Institute of Rheumatology, Prague, Czech Republic
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Sabína Oreská
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Maja Špiritović
- Institute of Rheumatology, Prague, Czech Republic
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Hana Štorkánová
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ladislav Šenolt
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Radim Bečvář
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Tomčík
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Panevin TS, Rozhivanov RV, Zotkin EG, Avdeeva AS, Glukhova SI. [Hypogonadism in men with inflammatory joint diseases: Frequency and clinical characteristics]. TERAPEVT ARKH 2024; 96:486-493. [PMID: 38829810 DOI: 10.26442/00403660.2024.05.202704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 06/05/2024]
Abstract
AIM To study the frequency of hypogonadism (HG) in men with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) and to evaluate the impact of HG on the course of RA and and concomitant diseases. MATERIALS AND METHODS A single-stage continuous study included 170 men with RA, 57 men with AS and 85 men with PsA, who were hospitalized at the Nasonova Research Institute of Rheumatology. Patients were assessed for total testosterone (ТS) levels and subsequently divided into subgroups with normal (>12 nmol/l) and reduced levels. An intergroup comparison was carried out on the main indicators used in clinical rheumatological practice to assess the stage, activity and other medical and demographic characteristics of rheumatic disease, as well as on concomitant conditions. The second stage of the study involved a pairwise intergroup comparison among patients with HG with RA, AS and PsA. RESULTS The incidence of ТS deficiency among patients with RA was 24.1%, among patients with AS - 17.5%, and with PsA - 31.8%. In patients with RA, HG was associated with a significantly higher mean body mass index, higher fasting blood glucose and uric acid, higher erythrocyte sedimentation rate and anemia. Patients with AS with HG had significantly lower hemoglobin levels and more frequent anemia, as well as higher levels of C-reactive protein and erythrocyte sedimentation rate. In PsA, older age was observed in the androgen deficiency group, as well as higher body mass index and fasting glucose levels; obesity was more common. An intergroup comparison of quantitative and qualitative indicators between patients with androgen deficiency in all three rheumatic diseases (RDs) did not reveal significant differences in the average concentrations of ТS, luteinizing hormone, sex hormone binding globulin, experience of RD, laboratory markers of inflammatory activity, as well as glucose and uric acid. A similar incidence of diabetes mellitus, obesity and anemia was noted for all three nosologies. CONCLUSION ТS levels and the presence of HG were not associated with the stage and activity of RD, but ТS deficiency was accompanied by higher laboratory indicators of inflammatory activity, lower hemoglobin values, and metabolic disorders. Patients with HG, regardless of nosology, had similar levels of sex hormones and indicators reflecting RD and concomitant conditions.
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MESH Headings
- Humans
- Male
- Hypogonadism/epidemiology
- Hypogonadism/blood
- Hypogonadism/diagnosis
- Middle Aged
- Testosterone/blood
- Arthritis, Psoriatic/epidemiology
- Arthritis, Psoriatic/complications
- Arthritis, Psoriatic/diagnosis
- Arthritis, Psoriatic/blood
- Adult
- Arthritis, Rheumatoid/epidemiology
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/blood
- Arthritis, Rheumatoid/diagnosis
- Spondylitis, Ankylosing/epidemiology
- Spondylitis, Ankylosing/complications
- Spondylitis, Ankylosing/diagnosis
- Spondylitis, Ankylosing/blood
- Spondylitis, Ankylosing/physiopathology
- Russia/epidemiology
- Incidence
- Blood Sedimentation
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Affiliation(s)
- T S Panevin
- Nasonova Research Institute of Rheumatology
- Far-East State Medical University
| | | | - E G Zotkin
- Nasonova Research Institute of Rheumatology
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Carrillo A, Marengo-Rodríguez D, Ibarra-Velasco-Siles M, Chávez-Barajas MJ, Barrera-Vargas A, Pérez-García LF, Merayo-Chalico J. Addressing the unspoken: sexual dysfunction in men with systemic lupus erythematosus, a call to action for rheumatologists. Sex Med Rev 2024:qeae033. [PMID: 38796305 DOI: 10.1093/sxmrev/qeae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/15/2024] [Accepted: 04/25/2024] [Indexed: 05/28/2024]
Abstract
INTRODUCTION Sexual dysfunction (SD) is highly prevalent and multifactorial; nevertheless, recent research has shed light on a notable phenomenon: male patients with systemic lupus erythematosus (SLE) exhibit an elevated prevalence of sexual function disorders compared with the general population. Despite this recognition, the precise nature and extent of this association remain incompletely understood. OBJECTIVES This comprehensive review aims to clarify the link by providing an overview of the fundamental components of normal male sexual function, delving into the pathogenesis of male SD and exploring the primary factors predisposing male SLE patients to SD. Additionally, the review offers insights into potential screening, diagnostic, and treatment strategies based on the current body of literature. METHODS A meticulous search of relevant literature was conducted using the PubMed and Google Scholar databases. RESULTS Studies exploring the correlation between SLE and SD in both genders have revealed a nearly 2-fold increased risk of SD among individuals with SLE compared with healthy counterparts. Moreover, these studies suggest that male SLE patients may have a higher susceptibility to SD, with reported prevalence ranging from 12% to 68%, compared with 0% to 22% in healthy individuals. Male patients with SLE are influenced by a spectrum of pathological factors, including pharmacological, psychological, and disease-related determinants, which, through their intricate interplay, elevate the likelihood of developing SD. CONCLUSION Healthcare professionals must remain vigilant in understanding the intricacies of human sexuality and its dysfunction, particularly in males with SLE. The objective is to establish effective and potentially standardized methods for promptly diagnosing and optimally managing SD, recognizing its significant impact on the quality of life for males living with SLE. The pivotal role of rheumatologists in initiating discussions about sexual health, diagnosing SD, investigating causes, and implementing tailored strategies is underscored as crucial in addressing this multifaceted issue.
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Affiliation(s)
- Abril Carrillo
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, 14080 Ciudad de México, Mexico
| | - Daniela Marengo-Rodríguez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, 14080 Ciudad de México, Mexico
| | - Monserrat Ibarra-Velasco-Siles
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, 14080 Ciudad de México, Mexico
| | - María José Chávez-Barajas
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, 14080 Ciudad de México, Mexico
| | - Ana Barrera-Vargas
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, 14080 Ciudad de México, Mexico
| | | | - Javier Merayo-Chalico
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, 14080 Ciudad de México, Mexico
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Sigmo GD, Hauge S, Hufthammer KO, Wallenius M, Salvesen KÅ, Daltveit AKN, Bakland G, Fevang BTS. Male patients with inflammatory joint diseases are less likely than controls to be childless: results from a Norwegian population-based cohort study of 10 865 patients. Ann Rheum Dis 2024; 83:457-463. [PMID: 38262688 PMCID: PMC10958328 DOI: 10.1136/ard-2023-224998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/25/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVES To investigate the number of children per man and the proportion of childless men as a proxy of fertility in a national cohort of men with inflammatory joint diseases (IJDs), compared with matched controls from the general population. METHODS This is a nationwide, population-based retrospective cohort study. Male patients with IJDs (n = 10 865) in the Norwegian Arthritis Registry were individually matched 1:5 on birth year and county of residence with men without IJDs obtained from the National Population Register (n = 54 325). Birth data were obtained from the Medical Birth Registry of Norway. We compared the mean number of children per man and the proportion of childless men and analysed the impact of age and year of diagnosis. RESULTS The mean number of children per man in the patient group was 1.80 versus 1.69 in the comparison group (p <0.001), and 21% of the patients in the patient group were childless versus 27% in the comparison group (p <0.001). The finding of less childlessness and higher number of children per man remained consistent across age at diagnosis, except for those diagnosed at age 0-19 years. The difference in childlessness was most pronounced for men diagnosed after year 2000, especially when diagnosed at 30-39 years of age (22% vs 32%, p<0.001). CONCLUSION In this large cohort study we found that patients with IJD have a higher number of children and are less likely to be childless compared with controls. Factors associated with developing or having an IJD might influence fertility and this requires further investigation.
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Affiliation(s)
- Gudrun David Sigmo
- Department of Rheumatology, Stavanger University Hospital, Stavanger, Norway
| | - Solveig Hauge
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | | | - Marianne Wallenius
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
- The Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Kjell Åsmund Salvesen
- Department of Obstetrics and Gynecology, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Kjersti Nesje Daltveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Medical Birth Registry, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway
- Department of Rheumatology, University of Tromsø, Tromsø, Norway
| | - Bjorg-Tilde Svanes Fevang
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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5
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Volkova N, Yukhta M, Goltsev A. DNA fragmentation, antioxidant activity and histological structure of cryopreserved testicular tissue depending on sexual maturity and immunological status. Cryobiology 2024; 114:104862. [PMID: 38360086 DOI: 10.1016/j.cryobiol.2024.104862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
The objective of this work was to determine a relationship between a frequency of DNA fragmentation, a level of antioxidant activity and a preservation of histological structure depending on initial status of fragments of seminiferous tubules of testes (FSTT) of rats at the stages of cryopreservation. FSTT of animals of different ages (immature, mature), as well as animals with changed immunological status (adjuvant arthritis) were cryopreserved. Slow uncontrolled freezing was used in a cryomedium of fibrin gel with 0.7 M glycerol. The results showed that viability, TAS, γGGT and G6PD activities had the highest values in the group of intact immature animals both in fresh FSTT and after exposure to cryomedium or cryopreservation, while the indexes of DNA fragmentation and ROS content had the lowest values. It was found that an increase in the DNA fragmentation rate occurred in parallel with a decrease in the values of antioxidant activity and membrane integrity. The spermatogenenic epithelium after cryopreservation differed between the groups in a relative number of cells with pathologically changed nuclei and the frequency of exfoliation of epithelial cells into the tubule cavity namely, there was a tendency to an increase in the damaging effects in the series, "Immature → Sexually mature → Autoimmune arthritis". The obtained data can be taken into account in the development of low-temperature preservation protocols using cryotechnologies, which will ensure the maintenance of the morphological and functional characteristics of FSTT depending on sexual maturity and immunological status.
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Affiliation(s)
- Nataliia Volkova
- Institute for Problems of Cryobiology and Cryomedicine, National Academy of Sciences of Ukraine, str. Pereyaslavska, 23, Kharkiv, 61016, Ukraine.
| | - Mariia Yukhta
- Institute for Problems of Cryobiology and Cryomedicine, National Academy of Sciences of Ukraine, str. Pereyaslavska, 23, Kharkiv, 61016, Ukraine
| | - Anatoliy Goltsev
- Institute for Problems of Cryobiology and Cryomedicine, National Academy of Sciences of Ukraine, str. Pereyaslavska, 23, Kharkiv, 61016, Ukraine
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Cirillo L, Fusco GM, Di Bello F, Morgera V, Cacace G, Di Mauro E, Mastrangelo F, Romano L, Calace FP, La Rocca R, Napolitano L. Sexual dysfunction: Time for a multidisciplinary approach? Arch Ital Urol Androl 2023; 95:11236. [PMID: 36924366 DOI: 10.4081/aiua.2023.11236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/17/2023] [Indexed: 03/17/2023] Open
Abstract
Sexual health impairment is one of the most important issues worldwide, with an increasing number of men and women affected. Specifically in male sexual dysfunction (SD), several risk factors were established such as atherosclerosis, hypertension, diabetes mellitus, smoking or obesity. The co-presence of more than one of risk factors identifies a condition, defined as the metabolic syndrome (MetS), related directly to the SD. However, not all the physicians involved in the MetS management routinely discussed the sexual impairment, increasing the bothering feelings of patients. Furthermore, the lack of knowledge, insufficient time, lack of attention, ambiguities about responsibility, insufficient training and experience, shared among physicians, regarding the communication and treatment of sexual dysfunction, are all reported factors involved in under-valuation of SD. The current paper represents a warning to the experts, with the aim of increasing the awareness of SD among clinicians and to promote the education, training and collaboration with sex therapists, through a multidisciplinary team, that can lead to a holistic approach in SD assessment and treatment.
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Affiliation(s)
- Luigi Cirillo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Giovanni Maria Fusco
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Francesco Di Bello
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Vincenzo Morgera
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Gianluigi Cacace
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Ernesto Di Mauro
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Francesco Mastrangelo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Lorenzo Romano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Francesco Paolo Calace
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Roberto La Rocca
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
| | - Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples.
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Westhovens R. Filgotinib in rheumatoid arthritis. Expert Rev Clin Immunol 2023; 19:135-144. [PMID: 36396615 DOI: 10.1080/1744666x.2023.2149495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Rheumatoid Arthritis (RA) remains a challenge for rheumatologists and patients despite implementation of intensive treat-to-target strategies in shared decision with patients and an increasing availability of drugs. Janus kinase inhibitors (JAKi) are a new generation of oral targeted drugs. Filgotinib preferentially inhibits JAK1 and is the latest JAKi to be approved for use in RA. AREAS COVERED This narrative review focuses on drug characteristics, efficacy, and safety of filgotinib in patients with RA, summarizing available literature. Trial data are detailed, put into perspective for practice and discussed in regulatory perspective. EXPERT OPINION Preclinical studies demonstrate preferential inhibition of JAK1 and a promising pharmacokinetic profile with few drug-drug interactions. Increase in hemoglobin in line with preferential inhibition of JAK1 over JAK2 is seen in early-phase clinical trials. A phase III program demonstrates efficacy in several disease stages, numerically higher with 200 mg versus 100 mg daily. In the overall RA population such dose-related effect is not observed for safety except for herpes zoster and increases in lipids and creatine phosphokinase. This reassuring safety profile is to be confirmed in future practice. It also needs to be unraveled if JAK1 preferential inhibition plays a key role in this safety profile.
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Affiliation(s)
- Rene Westhovens
- Emeritus Professor KU Leuven, Skeletal Biology and Engineering Research Center Department of Development and Regeneration, Leuven, Belgium
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Association between Brain Injury Markers and Testosterone in Critically-Ill COVID-19 Male Patients. Microorganisms 2022; 10:microorganisms10112095. [PMID: 36363686 PMCID: PMC9697553 DOI: 10.3390/microorganisms10112095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Accumulating data suggest that various neurologic manifestations are reported in critically-ill COVID-19 patients. Although low testosterone levels were associated with poor outcomes, the relationship between testosterone levels and indices of brain injury are still poorly understood. Therefore, we aimed to explore whether testosterone levels are associated with glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), biomarkers of brain injury, in patients with a severe form of COVID-19. The present study was conducted on 65 male patients aged 18−65 with severe COVID-19. Blood samples were collected at three time points: upon admission to ICU, 7 days after, and 14 days after. In patients with neurological sequels (n = 20), UCH-L1 serum concentrations at admission were markedly higher than in patients without them (240.0 (155.4−366.4) vs. 146.4 (92.5−243.9) pg/mL, p = 0.022). GFAP concentrations on admission did not differ between the groups (32.2 (24.2−40.1) vs. 29.8 (21.8−39.4) pg/mL, p = 0.372). Unlike GFAP, UCH-L1 serum concentrations exhibited a negative correlation with serum testosterone in all three time points (r = −0.452, p < 0.001; r = −0.430, p < 0.001 and r = −0.476, p = 0.001, respectively). The present study suggests that the traumatic brain injury biomarker UCH-L1 may be associated with neurological impairments seen in severe COVID-19. Moreover, a negative correlation between UCH-L1 and serum testosterone concentrations implies that testosterone may have a role in the development of neurological sequels in critically-ill COVID-19 patients.
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Bahnsen MK, Graugaard C, Andersson M, Andresen JB, Frisch M. Physical and Mental Health Problems and Their Associations With Inter-Personal Sexual Inactivity and Sexual Dysfunctions in Denmark: Baseline Assessment in a National Cohort Study. J Sex Med 2022; 19:1562-1579. [PMID: 35970709 DOI: 10.1016/j.jsxm.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/28/2022] [Accepted: 07/02/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Physical and mental health are important to sexual function and wellbeing. Yet, associations of ill-health with sexual inactivity and dysfunctions are scarcely researched at population level. AIM To explore and document associations of self-rated health and physical and mental health problems with inter-personal sexual inactivity and sexual dysfunctions. METHODS We used data from a probability-based, nationally representative sample of 60,958 sexually experienced Danes aged 15-89 years who participated in the 2017-18 Project SEXUS cohort study. Logistic regression analyses provided demographically weighted odds ratios for associations between health measures and sexual outcomes adjusted for partner status and other potential confounders. OUTCOMES Inter-personal sexual inactivity and a range of male and female sexual dysfunctions. RESULTS Inter-personal sexual inactivity was more common among individuals with bad or very bad self-rated health compared to peers rating their health as good or very good (men: adjusted odds ratio 1.93, 95% confidence interval 1.66-2.25; women: 1.66, 1.42-1.94). Individuals rating their health as bad or very bad were also consistently more likely to report sexual dysfunctions, with associated statistically significant adjusted odds ratios ranging from 1.66 to 6.38 in men and from 2.25 to 3.20 in women. Patient groups at high risk of sexual dysfunctions comprised individuals afflicted by cardiovascular diseases, pain conditions, diabetes, gastrointestinal and liver diseases, cancer, skin diseases, nervous system diseases, gynecological diseases, benign prostatic hyperplasia, other physical health problems, stress, anxiety, affective disorders, self-injury or suicide ideation and attempts, posttraumatic stress disorder, personality disorders, eating disorders, psychoses and other mental health problems. CLINICAL IMPLICATIONS These findings warrant heightened awareness among healthcare professionals, public health promoters and researchers concerning insufficiently appreciated sexual challenges among individuals with poor health. STRENGTHS & LIMITATIONS The major strengths of our investigation include the large size of the study cohort, the detailed assessment of health-related variables, potential confounders and sexual outcomes, and the fact that we provide new population-based knowledge about less common and sparsely researched sexual dysfunctions and diseases. Limitations of our study include its cross-sectional nature and its modest response rate (35%). CONCLUSION Findings from our large and nationally representative cohort study provide evidence that poor self-rated health and a range of specific physical and mental health problems are associated with statistically significantly increased rates of inter-personal sexual inactivity and sexual dysfunctions.
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How Do Mexican Patients With Rheumatoid Arthritis Define Sexual and Reproductive Health? A Content Analysis Study. J Clin Rheumatol 2022; 28:305-313. [PMID: 35612587 DOI: 10.1097/rhu.0000000000001860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND A patient-centered approach is essential for promoting sexual health (SH) and reproductive health (RH) in rheumatoid arthritis patients. The study aimed to describe and interpret Mexican rheumatoid arthritis outpatients' testimonies of their SH and RH definitions. METHODS Qualitative and quantitative content analysis was conducted on free-text comments from 219 and 223 descriptions of patients' SH and RH definitions, respectively. A comprehensive system of major themes, categories, and subcategories was structured for each definition. The representational foundations of these categories and the context of their production were analyzed. Integration of quantitative and qualitative content analysis was used to comprehend patients' definitions of SH and RH. Internal review board approved the study. RESULTS Ten major themes emerged for each definition, and their assigned frequencies differed between SH and RH definitions, and between groups of patients integrated according to age, education level, and sex. Both definitions had similar contents, expressed in the shared major themes and categories, and in managing at the same time SH- and RH-related contents within each definition. The "overall prevention-patient oriented care" major theme defined a common core for both definitions' contents. Meanwhile, a diversity of meanings was also evident particularly at the subcategory level. CONCLUSIONS In our population, SH content was distinguished by related diseases and their consequences, individual actions directed to prevention, and couple mentions. Meanwhile, RH was distinguished by a primarily biological perspective of the reproductive function, which was required at a particular life stage to concrete a family project.
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11
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Chies AB, Spadella MA, Carlos CP, Pacheco da Silva CB, Tirapelli CR. Orchiectomy but not adjuvant-induced arthritis induces structural modifications in rat aortas. J Smooth Muscle Res 2022; 58:63-77. [PMID: 35944980 PMCID: PMC9364264 DOI: 10.1540/jsmr.58.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: This study aimed to verify whether Adjuvant-Induced Arthritis (AIA) and/or
Orchiectomy (ORX) modify the expression of the Nox1, Nox2 and Nox4 isoforms, the
endothelial function or the structure of rat aortas. Methods: Sixty-three Wistar rats were
distributed into four groups: 1) Control; 2) ORX; 3) AIA; 4) Orchiectomy plus to
Arthritis-induction (ORX/AIA). Thus, 21 days after the onset of AIA (by intradermal
injection of Mycobacterium tuberculosis), the presence of Nox1, Nox2 and
Nox4, the acetylcholine (ACh)-induced relaxation and the media layer thickness were
assessed in the aorta taken from these animals. Results: The Nox1, Nox2 and Nox4 were
immunostained in intima, media and adventitia layers of aortas taken from all studied
groups and AIA apparently increased this immunostaining. These modifications of Nox1, Nox2
or Nox4 expression, however, were not confirmed by Western blotting. In addition, neither
AIA nor ORX changed the endothelial function, but ORX increased the media layer thickness
in the studied aortas. Conclusion: The present study showed weak clues of increased
expression of Nox1, Nox2 and Nox4 as a result of AIA, as well as of Nox1 reduction caused
by ORX. In addition, the endothelial function was not modified in the aortas of these
animals by both AIA and/or ORX. On the other hand, ORX increased significantly the aorta
media layer thickness in the studied animals, which was apparently mitigated by AIA.
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Affiliation(s)
- Agnaldo Bruno Chies
- Laboratory of Pharmacology, Marília Medical School, Av. Monte Carmelo, 800, Fragata, Marília, São Paulo 17 519-030, Brazil
| | - Maria Angélica Spadella
- Laboratory of Human Embryology, Marília Medical School, Av. Monte Carmelo, 800, Fragata, Marília, São Paulo 17 519-030, Brazil
| | - Carla Patrícia Carlos
- Laboratory of Experimental Research, FACERES School of Medicine, Jardim Morumbi, São José do Rio Preto, São Paulo 15090-305, Brazil
| | | | - Carlos Renato Tirapelli
- Laboratório de Farmacologia, DEPCH, Escola de Enfermagem de Ribeirão Preto, USP, Ribeirão Preto, São Paulo, Brazil
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12
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Al-Hamamah MA, Alotaibi MR, Ahmad SF, Nadeem A, Attia MSM, Ansari MA, Bakheet SA, Alanazi MM, Attia SM. Treatment with the anti-CD20 monoclonal antibody rituximab mitigates gonadal disruptions in the collagen-induced arthritis in male DBA/1 J mouse model. Mutat Res 2022; 825:111799. [PMID: 36108541 DOI: 10.1016/j.mrfmmm.2022.111799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/08/2022] [Accepted: 09/04/2022] [Indexed: 06/15/2023]
Abstract
Rheumatoid arthritis (RA), which is driven by persistent activation of the immune system, primarily affects the joints. Several reports have estimated the risk of gonadal disruptions in arthritic patients, with potential attributable risk factors such as treatments with the disease-modifying antirheumatic drugs and the influence of the disease itself. The FDA approved rituximab, a therapy for non-Hodgkin's lymphoma, for management of RA in February 2006. However, the influence of repeated treatment with rituximab on gonadal function in RA has not been reported yet. Thus, the aim of the presents study is to evaluate whether repeated treatment with the clinically relevant dose of rituximab may change the gonadal disruptions in collagen-induced arthritis in male DBA/1 J mouse, a model of RA. Testicular disruptions, as determined by the sperm DNA strand breaks, spermatocyte chromosomal analysis and spermiogram examination have been conducted by the use of standard techniques. Additionally, we aimed to test whether the anti-rheumatic effect of rituximab also decreases the cellular oxidant-antioxidant imbalance in arthritic male DBA/1 J mice. Repeated treatment of naïve control DBA/1 J mice with rituximab did not exhibit any significant deleterious effects. Moreover, repeated administration of rituximab to the arthritic DBA/1 J mice suppressed disease severity and decreased testicular disruptions. Rituximab treatment also diminished gonadal oxidative stress, through decreasing reactive oxygen species generation and restoring the reduced glutathione level in arthritic DBA/1 J mice. In conclusion, rituximab is a safe therapeutic agent and can mitigate gonadal disruptions induced by arthritis, which insinuates the importance for arthritic patients especially at reproductive age.
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Affiliation(s)
- Mohammed A Al-Hamamah
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Moureq R Alotaibi
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Sheikh F Ahmad
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Ahmed Nadeem
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia.
| | - Mohamed S M Attia
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mushtaq A Ansari
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Saleh A Bakheet
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mohammed M Alanazi
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Sabry M Attia
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia.
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13
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Hellstrom WJG, Dolhain RJEM, Ritter TE, Watkins TR, Arterburn SJ, Dekkers G, Gillen A, Tonussi C, Gilles L, Oortwijn A, Van Beneden K, de Vries DE, Sikka SC, Vanderschueren D, Reinisch W. MANTA and MANTA-RAy: Rationale and Design of Trials Evaluating Effects of Filgotinib on Semen Parameters in Patients with Inflammatory Diseases. Adv Ther 2022; 39:3403-3422. [PMID: 35614292 PMCID: PMC9239965 DOI: 10.1007/s12325-022-02168-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/14/2022] [Indexed: 12/22/2022]
Abstract
Introduction The phase 2 MANTA and MANTA-RAy studies were developed in consultation with global regulatory authorities to investigate potential impacts of filgotinib, a Janus kinase 1 preferential inhibitor, on semen parameters in men with active inflammatory diseases. Here we describe the methods and rationale for these studies. Methods and Rationale The MANTA and MANTA-RAy studies included men (aged 21–65 years) with active inflammatory bowel disease (IBD) and rheumatic diseases, respectively. Participants had no history of reproductive health issues, and the following semen parameter values (≥ 5th percentile of World Health Organization reference values) at baseline: semen volume ≥ 1.5 mL, total sperm/ejaculate ≥ 39 million, sperm concentration ≥ 15 million/mL, sperm total motility ≥ 40% and normal sperm morphology ≥ 30%. Each trial included a 13-week, randomized, double-blind, placebo-controlled period (filgotinib 200 mg vs placebo, up to N = 125 per arm), for pooled analysis of the week-13 primary endpoint (proportion of participants with ≥ 50% decrease from baseline in sperm concentration). All semen assessments were based on two samples (≤ 14 days apart) to minimize effects of physiological variation; stringent standardization processes were applied across assessment sites. From week 13, MANTA and MANTA-RAy study designs deviated owing to disease-specific considerations. All subjects with a ≥ 50% decrease in sperm parameters continued the study in the monitoring phase until reversibility, or up to a maximum of 52 weeks, with standard of care as treatment. Overall conclusions from MANTA and MANTA-RAy will be based on the totality of the data, including secondary/exploratory measures (e.g. sperm motility/morphology, sex hormones, reversibility of any effects on semen parameters). Conclusions Despite the complexities, the MANTA and MANTA-RAy studies form a robust trial programme that is the first large-scale, placebo-controlled evaluation of potential impacts of an advanced IBD and rheumatic disease therapy on semen parameters. Trial Registration EudraCT numbers 2017-000402-38 and 2018-003933-14; ClinicalTrials.gov identifiers NCT03201445 and NCT03926195. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02168-4. Filgotinib is a treatment for patients with ulcerative colitis and rheumatoid arthritis, and is being studied in other inflammatory diseases. Filgotinib works by blocking Janus kinase 1, an intracellular protein involved in inflammatory signalling processes. We designed the MANTA and MANTA-RAy trials with global health agencies to find out if filgotinib decreases the quality of semen in men with active inflammatory bowel disease (ulcerative colitis or Crohn’s disease) (MANTA) or rheumatic disease (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis or non-radiographic axial spondylitis) (MANTA-RAy). This paper describes the design of the two trials. Patients had normal sperm measurements and could not have had previous reproductive health issues. Nearly 250 patients were included in each trial. In both MANTA and MANTA-RAy, half of the patients were treated with 200 mg of filgotinib once a day for 13 weeks, and the other half with placebo. We determined if any patients had a decrease in number of sperm cells per millilitre (sperm concentration) by at least half after 13 weeks of treatment. We then monitored any patients who had such a decrease in sperm concentration for up to 52 weeks (while they received standard of care treatment) or until the decrease was reversed. The conclusions from the trials will be in a different paper and will be based on all the final data, including changes in sex hormones. This is the first large-scale clinical trial programme to measure the effect of a treatment on sperm in men with inflammatory bowel disease or rheumatic diseases.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Suresh C Sikka
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Dirk Vanderschueren
- Laboratory of Experimental and Clinical Endocrinology, KU Leuven, Leuven, Belgium
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14
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Ostrowska M, Świniarski P, Ostrowski A, Kowalski FR, Adamowicz J, Grzanka D, Drewa TA, Juszczak K. Sarcoidosis of the spermatic cord - case report and literature review. Basic Clin Androl 2022; 32:7. [PMID: 35590251 PMCID: PMC9118738 DOI: 10.1186/s12610-022-00158-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/05/2022] [Indexed: 12/02/2022] Open
Abstract
Background Sarcoidosis is a multi-system disease characterized by the formation of non-caseating granulomas in various organs. The lungs remain the most frequently affected organ, whereas lesions in the genitourinary system affect around 0.2% of patients. The primary site found in the spermatic cord is extremely rare. Case presentation We present a patient’s case where the spermatic cord involvement was the first manifestation of sarcoidosis. For several months, a number of tests had been performed, which showed, among others, non-caseating granulomas in pathomorphological material, bilateral hilar lymphadenopathy, and leukopenia with lymphopenia. Tumor markers were normal. Infection with urogenital pathogens (including Chlamydia Trachomatis, Neisseria gonorrhea, Mycoplasma hominis) was excluded. The patient did not report any general symptoms such as fever, excessive fatigue, weight loss. He denied swelling, shortness of breath. At the same time, a complete differential diagnosis was carried out, and the extent of the disease was assessed. Due to interdisciplinary management, the patient’s quality of life and fertility is preserved. In the discussion, we present the diagnosis, treatment, and prognosis of such patients. Conclusion Sarcoidosis is a multi-system disease, which should not be omitted in the differential diagnosis. Selective excision of the lesion with intraoperative examination plays a significant role while establishing a diagnosis. However, in the primary site in the genitourinary system, the diagnosis is challenging.
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Affiliation(s)
- Magdalena Ostrowska
- Department of Urology, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Piotr Świniarski
- Department of Urology, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Adam Ostrowski
- Department of Urology, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland.
| | - Filip Ryszard Kowalski
- Department of Urology, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Jan Adamowicz
- Department of Urology, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Dariusz Grzanka
- Department of Clinical Pathomorphology, Faculty of Medicine, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Tomasz Adam Drewa
- Department of Urology, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Kajetan Juszczak
- Department of Urology, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
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15
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Marinelli L, Beccuti G, Zavattaro M, Cagnina S, Gesmundo I, Bona C, Lopez C, Scabini S, Canta F, Mornese Pinna S, Lupia T, Di Bisceglie C, Ponzetto F, Settanni F, De Rosa FG, Ghigo E, Motta G. Testosterone as a Biomarker of Adverse Clinical Outcomes in SARS-CoV-2 Pneumonia. Biomedicines 2022; 10:biomedicines10040820. [PMID: 35453570 PMCID: PMC9025790 DOI: 10.3390/biomedicines10040820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 12/12/2022] Open
Abstract
Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may affect testicles. Lower testosterone levels have been associated with worse clinical outcomes and higher mortality. Our objective was to evaluate the hypothalamic−pituitary−gonadal axis of men admitted with SARS-CoV-2 pneumonia and its link with the pneumonia-treatment intensification. Short-term changes in hormonal parameters were also assessed. Methods: Men admitted with SARS-CoV-2 pneumonia were recruited in two different hospitals in Piedmont, Italy. In all patients, the assessment of total testosterone (TT), calculated free testosterone (cFT), gonadotropins, inhibin B (InhB), and other biochemical evaluations were performed at admission (T0) and before discharge (T1). Through a review of medical records, clinical history was recorded, including data on pneumonia severity. Results: Thirty-five men (median age 64 [58−74] years) were recruited. Lower TT and cFT levels at T0 were associated with CPAP therapy (p = 0.045 and 0.028, respectively), even after adjusting for age and PaO2/FIO2 ratio in a multivariable analysis. In those discharged alive, lower TT and cFT levels were associated with longer hospital stay (p < 0.01). TT, cFT, and InhB were below the normal range at T0 and significantly increased at T1 (TT 1.98 [1.30−2.72] vs. 2.53 [1.28−3.37] ng/mL, p = 0.038; cFT (0.0441 [0.0256−0.0742] vs. 0.0702 [0.0314−0.0778] ng/mL, p = 0.046; InhB 60.75 [25.35−88.02] vs. 77.05 [51.15−134.50], p < 0.01). Conclusions: Both TT and cFT levels are associated with adverse clinical outcomes in men admitted with SARS-CoV-2 pneumonia. As TT, cFT and InhB levels increase before discharge, short-term functional recovery of steroidogenesis and an indirect improvement of spermatozoa functional status could be hypothesized.
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Affiliation(s)
- Lorenzo Marinelli
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (G.B.); (S.C.); (I.G.); (C.B.); (C.L.); (C.D.B.); (F.P.); (E.G.)
- Correspondence: (L.M.); (G.M.)
| | - Guglielmo Beccuti
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (G.B.); (S.C.); (I.G.); (C.B.); (C.L.); (C.D.B.); (F.P.); (E.G.)
| | - Marco Zavattaro
- Division of Endocrinology, University Hospital “Maggiore della Carità”, 28100 Novara, Italy;
| | - Serena Cagnina
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (G.B.); (S.C.); (I.G.); (C.B.); (C.L.); (C.D.B.); (F.P.); (E.G.)
| | - Iacopo Gesmundo
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (G.B.); (S.C.); (I.G.); (C.B.); (C.L.); (C.D.B.); (F.P.); (E.G.)
| | - Chiara Bona
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (G.B.); (S.C.); (I.G.); (C.B.); (C.L.); (C.D.B.); (F.P.); (E.G.)
| | - Chiara Lopez
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (G.B.); (S.C.); (I.G.); (C.B.); (C.L.); (C.D.B.); (F.P.); (E.G.)
| | - Silvia Scabini
- Division of Infectious Diseases, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (S.S.); (F.C.); (S.M.P.); (F.G.D.R.)
| | - Francesca Canta
- Division of Infectious Diseases, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (S.S.); (F.C.); (S.M.P.); (F.G.D.R.)
| | - Simone Mornese Pinna
- Division of Infectious Diseases, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (S.S.); (F.C.); (S.M.P.); (F.G.D.R.)
| | - Tommaso Lupia
- Unit of Infectious Diseases, Cardinal Massaia Hospital, 14100 Asti, Italy;
| | - Cataldo Di Bisceglie
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (G.B.); (S.C.); (I.G.); (C.B.); (C.L.); (C.D.B.); (F.P.); (E.G.)
| | - Federico Ponzetto
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (G.B.); (S.C.); (I.G.); (C.B.); (C.L.); (C.D.B.); (F.P.); (E.G.)
| | - Fabio Settanni
- Clinical Biochemistry Laboratory, AOU Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy;
| | - Francesco Giuseppe De Rosa
- Division of Infectious Diseases, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (S.S.); (F.C.); (S.M.P.); (F.G.D.R.)
| | - Ezio Ghigo
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (G.B.); (S.C.); (I.G.); (C.B.); (C.L.); (C.D.B.); (F.P.); (E.G.)
| | - Giovanna Motta
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (G.B.); (S.C.); (I.G.); (C.B.); (C.L.); (C.D.B.); (F.P.); (E.G.)
- Correspondence: (L.M.); (G.M.)
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16
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Boussaid S, Makhlouf Y, Rekik S, Jammali S, Cheour E, Sahli H, Elleuch M, Ben Saad H. The effects of autoimmune rheumatic-related diseases on male reproductive health: A systematic review. J Reprod Immunol 2022; 150:103472. [PMID: 34998078 DOI: 10.1016/j.jri.2021.103472] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 11/24/2021] [Accepted: 12/30/2021] [Indexed: 11/26/2022]
Abstract
Autoimmune rheumatic-related diseases (ARRDs) have physical and psychological impact on patients, including their sexual life. While many studies have investigated fertility problems in females, data on males-related fertility are scarce, which explains the lack of guidance. The main objective of this systematic review was to evaluate the reproductive health in males with ARRDs. This systematic review followed the preferred reporting items for systematic reviews guidelines. Original articles from Pubmed and Scopus, published until September 16, 2021, and tackling the effects of ARRDs and/or ARRDs treatments on male fertility and/or pregnancy outcomes, were included. A total of twenty-five studies met the inclusion criteria. They were published between 1981 and 2018. The studied ARRDs were spondyloarthritis (n = 9), systematic lupus erythematosus (SLE, n = 6), Behcet disease (BD, n = 5), rheumatoid arthritis (RA, n = 5), antiphospholipid syndrome (n = 1), and dermatomyositis (n = 1). The most reported effects of ARRDs on fertility are i) high levels of reproductive hormones, mainly in RA and SLE; ii) impaired semen quality in SLE, spondyloarthritis, and BD; and iii) higher rate of varicocele in BD and spondyloarthritis. Regarding the treatments effects, i) conventional synthetic disease-modifying anti-rheumatic drugs (e.g.; methotrexate and salazopyrine) increase testosterone level, ii) cyclophosphamide impairs fertility, iii) anti-tumor necrosis factor agents are associated with improvement in semen quality, and iv) no increased number of miscarriages or congenital abnormalities in children fathered by BD was reported. To conclude, both ARRDs and their treatments alter fertility in males with ARRDs. In practice, in addition to the conventional semen analysis, screening for infertility seems legitimate in males with ARRDs.
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Affiliation(s)
- Soumaya Boussaid
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia; Research Unit LR 05 SP 01, la Rabta Hospital, Tunisia.
| | - Yasmine Makhlouf
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia.
| | - Sonia Rekik
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia; Research Unit LR 05 SP 01, la Rabta Hospital, Tunisia.
| | - Samia Jammali
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia; Research Unit LR 05 SP 01, la Rabta Hospital, Tunisia.
| | - Elhem Cheour
- Pain Treatment center, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia; Research Unit LR 05 SP 01, la Rabta Hospital, Tunisia.
| | - Hela Sahli
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia; Research Unit LR 05 SP 01, la Rabta Hospital, Tunisia.
| | - Mohamed Elleuch
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia.
| | - Helmi Ben Saad
- Université de Sousse, Faculté de Médecine de Sousse, Service de Physiologie et Explorations Fonctionnelles, Sousse, Tunisie; Université de Sousse, Hôpital Farhat HACHED, Service de Physiologie et Explorations Fonctionnelles, Sousse, Tunisia; Université de Sousse, Hôpital Farhat HACHED, Laboratoire de recherche LR12SP09 «Insuffisance cardiaque», Sousse, Tunisia.
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17
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Perez-Garcia LF, Röder E, Smeele HTW, Goekoop R, Hazes JMW, Kok MR, Tchetverikov I, van der Helm-van Mil A, van der Kaap J, Kok P, Krijthe P BP, Dolhain RJEM. Paternal inflammatory arthritis is associated with a higher risk of miscarriage: results of a large multicenter study (iFAME-Fertility). Rheumatology (Oxford) 2021; 61:3390-3395. [PMID: 34875039 PMCID: PMC9348772 DOI: 10.1093/rheumatology/keab910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/01/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives Paternal preconception health is recognized as an important contributor to pregnancy outcomes. Nonetheless, pregnancy outcomes of partners of men with inflammatory arthritis (IA) have never been studied. Our objective was to describe the pregnancy outcomes of partners of men diagnosed with IA. Methods We performed a multicentre cross-sectional retrospective study conducted in the Netherlands. Men with IA who were over 40 years old that reported at least one positive pregnancy test were included. To analyse the impact of IA on pregnancy outcomes, pregnancies were classified into two groups: pregnancies conceived after the diagnosis of IA and before the diagnosis of IA. Results In total, 408 male participants diagnosed with IA reported 897 singleton pregnancies that resulted in 794 live births. Pregnancies conceived after the diagnosis of IA had higher rate of miscarriage (12.27 vs 7.53%, P = <0.05). This increased risk was still present after adjusting for confounders [OR 2.03 (95% CI 1.12, 3.69) P = 0.015]. Conclusions This is the largest study to describe the pregnancy outcomes of partners of men diagnosed with IA and the first to demonstrate that paternal IA is associated with a higher risk of miscarriage. Notwithstanding, the overall rate of miscarriage reported in our study could be comparable to previously reported population estimates.
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Affiliation(s)
- Luis F Perez-Garcia
- Department of Rheumatology, Erasmus MC, University Medical Center, The Netherlands., Rotterdam
| | - Esther Röder
- Department of Rheumatology, Erasmus MC, University Medical Center, The Netherlands., Rotterdam
| | - Hieronymus T W Smeele
- Department of Rheumatology, Erasmus MC, University Medical Center, The Netherlands., Rotterdam
| | - Robbert Goekoop
- Department of Rheumatology, Haga Hospital, The Hague, The Netherlands
| | - Johanna M W Hazes
- Department of Rheumatology, Erasmus MC, University Medical Center, The Netherlands., Rotterdam
| | - Marc R Kok
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Ilja Tchetverikov
- Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Annette van der Helm-van Mil
- Department of Rheumatology, Erasmus MC, University Medical Center, The Netherlands., Rotterdam.,Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos van der Kaap
- Department of Rheumatology, Erasmus MC, University Medical Center, The Netherlands., Rotterdam.,Department of Rheumatology, Admiraal de Ruyter Hospital, Goes, The Netherlands
| | - Petra Kok
- Department of Rheumatology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Bouwe P Krijthe P
- Department of Rheumatology, Erasmus MC, University Medical Center, The Netherlands., Rotterdam.,Department of Rheumatology, Sint Franciscus Vlietland Group, Rotterdam, Netherlands
| | - Radboud J E M Dolhain
- Department of Rheumatology, Erasmus MC, University Medical Center, The Netherlands., Rotterdam
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18
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Perez-Garcia LF, Röder E, Goekoop RJ, Hazes JMW, Kok MR, Smeele HTW, Tchetverikov I, van der Helm-van Mil AHM, van der Kaap JH, Kok P, Krijthe BP, Dolhain RJEM. Impaired fertility in men diagnosed with inflammatory arthritis: results of a large multicentre study (iFAME-Fertility). Ann Rheum Dis 2021; 80:1545-1552. [PMID: 34373257 PMCID: PMC8600610 DOI: 10.1136/annrheumdis-2021-220709] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/09/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The impact of inflammatory arthritis (IA) on male fertility remains unexplored. Our objective was to evaluate the impact of IA on several male fertility outcomes; fertility rate (number of biological children per man), family planning, childlessness and fertility problems. METHODS We performed a multicentre cross-sectional study (iFAME-Fertility). Men with IA 40 years or older who indicated that their family size was complete were invited to participate. Participants completed a questionnaire that included demographic, medical and fertility-related questions. To analyse the impact of IA on fertility rate, patients were divided into groups according to the age at the time of their diagnosis: ≤30 years (before the peak of reproductive age), between 31 and 40 years (during the peak) and ≥41 years (after the peak). RESULTS In total 628 participants diagnosed with IA were included. Men diagnosed ≤30 years had a lower mean number of children (1.32 (SD 1.14)) than men diagnosed between 31 and 40 years (1.60 (SD 1.35)) and men diagnosed ≥41 years (1.88 (SD 1.14)).This was statistically significant (p=0.0004).The percentages of men diagnosed ≤30 and 31-40 years who were involuntary childless (12.03% vs 10.34% vs 3.98%, p=0.001) and who reported having received medical evaluations for fertility problems (20.61%, 20.69% and 11.36%, p=0.027) were statistically significant higher than men diagnosed ≥41 years. CONCLUSIONS This is the first study that shows that IA can impair male fertility. Men diagnosed with IA before and during the peak of reproductive age had a lower fertility rate, higher childlessness rate and more fertility problems. Increased awareness and more research into the causes behind this association are urgently needed.
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Affiliation(s)
| | - Esther Röder
- Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Johanna M W Hazes
- Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marc R Kok
- Rheumatology and Clinical Immunology, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | | | - Ilja Tchetverikov
- Rheumatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Annette H M van der Helm-van Mil
- Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos H van der Kaap
- Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Rheumatology, Admiraal De Ruyter Hospital, Goes, The Netherlands
| | - Petra Kok
- Rheumatology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Bouwe P Krijthe
- Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Rheumatology, Sint Franciscus Vlietland Group, Rotterdam, The Netherlands
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19
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Perez-Garcia LF, Röder E, Pastoor H, Bolt JM, van Exel J, Dolhain RJEM. It is not just about sex: viewpoints of men with inflammatory arthritis on the overall impact of the disease on their sexual health. RMD Open 2021; 7:rmdopen-2021-001821. [PMID: 34580174 PMCID: PMC8477326 DOI: 10.1136/rmdopen-2021-001821] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/10/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives Sexual health is defined as a state of physical, emotional, mental and social well-being in relation to sexuality. The impact of inflammatory arthritis (IA) on male sexual health has been mainly studied focusing on erectile function, one of the physical components of sexual health. Our objective was to describe the viewpoints among men with IA in the Netherlands on the overall impact of IA on their sexual health. Methods Q-methodology, a mixed methods approach to systematically study subjectivity was used. Adult men diagnosed with IA ranked 34 opinion statements about potential impacts of IA on their sexual health and were interviewed. By-person factor analysis was used to identify common patterns in the rankings, which were interpreted as viewpoints. Data from the interviews were used to verify and adjust the interpretations. Results 30 men (22–77 years) with IA were included. The analysis revealed three viewpoints. Men with the viewpoint ‘Arthritis negatively affects my sexual health’ experience a dramatic impact on all components of sexual health. In viewpoint ‘I am keeping up appearances’, IA negatively impacts sexual health but a distinguishing coping mechanism could mask a more serious negative impact. Men with the viewpoint ‘I am satisfied with my sexual health’' experience no significant impact of IA on their sexual health. Conclusions We identified three viewpoints on the impact of IA on male sexual health, two revealed a negative influence that goes beyond the physical act of sex. IA can severely affect the emotional, mental and social components of sexual health.
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Affiliation(s)
| | - Esther Röder
- Department of Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Hester Pastoor
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Johanna M Bolt
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Job van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Radboud J E M Dolhain
- Department of Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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20
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Meißner Y, Strangfeld A. [Insights into pregnancy and breastfeeding in inflammatory rheumatic diseases through observational data]. Z Rheumatol 2021; 80:733-742. [PMID: 34535821 DOI: 10.1007/s00393-021-01082-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 11/24/2022]
Abstract
Information on pregnancy and breastfeeding in women with chronic inflammatory rheumatic diseases is relevant for a successful pregnancy and also for maternal and child health. In general, pregnant and breastfeeding women are excluded from randomized clinical trials and therefore evidence for clinical care and counselling has to be generated from observational studies. In the past decades, various data collections have been established for this purpose in addition to the existing spontaneous reporting systems initiated by drug authorities, with the aim of monitoring the teratogenic risk of a drug. Health insurance claims data, electronic health records and Scandinavian registers are also increasingly being used for research on pregnancy-associated events; however, all these data sources lack the inclusion of the maternal disease, especially with respect to its inflammatory component. Established cohort studies, biologics and disease registries record disease activity but are not designed for pregnancy-specific questions. Pregnancy registries and studies in rheumatology close this gap. In order to be able to make a better assessment of the possibilities and limitations of existing data sources on pregnancy and lactation, they are presented in detail in the following review including their respective advantages and disadvantages and examples from rheumatology are given. In addition, existing collaborations as well as studies for investigating the influence of paternal rheumatic disease are highlighted.
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Affiliation(s)
- Yvette Meißner
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Anja Strangfeld
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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21
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Perez-Garcia LF, Dolhain RJEM, Vorstenbosch S, Bramer W, van Puijenbroek E, Hazes JMW, Te Winkel B. The effect of paternal exposure to immunosuppressive drugs on sexual function, reproductive hormones, fertility, pregnancy and offspring outcomes: a systematic review. Hum Reprod Update 2021; 26:961-1001. [PMID: 32743663 PMCID: PMC7600290 DOI: 10.1093/humupd/dmaa022] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/17/2020] [Accepted: 05/01/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Information regarding the possible influence of immunosuppressive drugs on male sexual function and reproductive outcomes is scarce. Men diagnosed with immune-mediated diseases and a wish to become a father represent an important neglected population since they lack vital information to make balanced decisions about their treatment. OBJECTIVE AND RATIONALE The aim of this research was to systematically review the literature for the influence of paternal immunosuppressive drug use on many aspects of male sexual health, such as sexual function, fertility, pregnancy outcomes and offspring health outcomes. SEARCH METHODS A systematic literature search was performed in the bibliographic databases: Embase (via Elsevier embase.com), MEDLINE ALL via Ovid, Cochrane Central Register of Trials (via Wiley) and Web of Science Core Collection. Additionally, Google Scholar and the Clinical trial registries of Europe and the USA were searched. The databases were searched from inception until 31 August 2019. The searches combined keywords regarding male sexual function and fertility, pregnancy outcomes and offspring health with a list of immunosuppressive drugs. Studies were included if they were published in English and if they included original data on male human exposure to immunosuppressive drugs. A meta-analysis was not possible to perform due to the heterogeneity of the data. OUTCOMES A total of 5867 references were identified, amongst which we identified 161 articles fulfilling the eligibility criteria. Amongst these articles, 50 included pregnancy and offspring outcomes and 130 included sexual health outcomes. Except for large Scandinavian cohorts, most of the identified articles included a small number of participants. While a clear negative effect on sperm quality was evident for sulfasalazine and cyclophosphamide, a dubious effect was identified for colchicine, methotrexate and sirolimus. In three articles, exposure to tumour necrosis factor-α inhibitors in patients diagnosed with ankylosing spondylitis resulted in improved sperm quality. The information regarding pregnancy and offspring outcomes was scant but no large negative effect associated with paternal immunosuppressive drug exposure was reported. WIDER IMPLICATIONS Evidence regarding the safety of immunosuppressive drugs in men with a wish to become a father is inconclusive. The lack of standardisation on how to evaluate and report male sexual function, fertility and reproduction as study outcomes in men exposed to immunosuppressive drugs is an important contributor to this result. Future research on this topic is needed and should be preferably done using standardised methods.
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Affiliation(s)
- L F Perez-Garcia
- Department of Rheumatology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - R J E M Dolhain
- Department of Rheumatology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - S Vorstenbosch
- Netherlands Pharmacovigilance Centre Lareb, 5237 MH 's-Hertogenbosch, The Netherlands
| | - W Bramer
- Medical Library, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - E van Puijenbroek
- Netherlands Pharmacovigilance Centre Lareb, 5237 MH 's-Hertogenbosch, The Netherlands.,Groningen Research Institute of Pharmacy, PharmacoTherapy, Epidemiology and Economics, University of Groningen, 9712 CP Groningen, The Netherlands
| | - J M W Hazes
- Department of Rheumatology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - B Te Winkel
- Netherlands Pharmacovigilance Centre Lareb, 5237 MH 's-Hertogenbosch, The Netherlands
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22
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Ledón-LLanes L, Contreras-Yáñez I, Guaracha-Basáñez G, Valverde-Hernández SS, González-Marín A, Ballinas-Sánchez ÁDJ, Durand M, Pascual-Ramos V. Views of Mexican outpatients with rheumatoid arthritis on sexual and reproductive health: A cross-sectional study. PLoS One 2021; 16:e0245538. [PMID: 33507948 PMCID: PMC7842945 DOI: 10.1371/journal.pone.0245538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/30/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) impacts sexual and reproductive health (SRH), which is a prominent component of a patient´s quality of life and highly influenced by the cultural background. The aim of the study was to explore the interest of Mexican outpatients with RA in SRH and to examine patient view on SRH. METHODS This cross-sectional study surveyed 303 consecutive outpatients with RA on their perceptions of SRH importance, SRH satisfaction, access to SRH information, preferences regarding SRH communication with healthcare professionals, and understanding of SRH (qualitative open-ended descriptions). Descriptive statistics and inferential analysis were used. Patient knowledge of each dimension of SRH was rated based on pre-specified criteria. Two assessors assigned ten major themes to each patient´s description of both dimensions of SRH. RESULTS Patients perceived their SRH as an important component of their general health and wished to address the topic, although few had access to such communication. Female patients assigned lesser importance to SRH, showed lesser degree of satisfaction with SRH, and expressed preference for a truthful physician. Age showed a linear association with individual survey responses, except for satisfaction with reproductive health dimension. There was a linear association between increased age and decreased years of formal education with a lower level of SRH knowledge. Ten major themes emerged for each of the two dimensions of the SRH construct, although most individual descriptions were assigned to one or two major themes. CONCLUSIONS Further education and assessment of SRH in Mexican patients with RA is warranted.
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Affiliation(s)
- Loraine Ledón-LLanes
- Department of Biology of Reproduction, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Irazú Contreras-Yáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Guillermo Guaracha-Basáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Salvador Saúl Valverde-Hernández
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Anayanci González-Marín
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ángel de Jesús Ballinas-Sánchez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Marta Durand
- Department of Biology of Reproduction, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Virginia Pascual-Ramos
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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23
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Wilton KM, Achenbach SJ, Davis JM, Myasoedova E, Matteson EL, Crowson CS. Erectile Dysfunction and Cardiovascular Risk in Men With Rheumatoid Arthritis: A Population-based Cohort Study. J Rheumatol 2021; 48:1641-1647. [PMID: 33452166 DOI: 10.3899/jrheum.201226] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Both erectile dysfunction (ED) and rheumatoid arthritis (RA) are associated with increased cardiovascular (CV) risk. It is unknown if these diagnoses are associated or if their combination confers additional CV risk. We aimed to define the incidence of ED in RA, and to determine if ED correlates with increased CV risk in RA. METHODS Medical information concerning RA, ED, and CV diagnoses for men with RA (n = 260) diagnosed in Olmsted County, Minnesota, and age-matched male comparators was extracted from a comprehensive medical record system. RESULTS ED incidence was similar between the RA cohort and comparators (HR 0.80, 95% CI 0.55-1.16). In men with RA, ED diagnosis was associated with a trend toward an increase in peripheral arterial disease (HR 2.22, 95% CI 0.98-5.03) and a significantly decreased rate of myocardial infarction (HR 0.26, 95% CI 0.07-0.90), heart failure (HR 0.49, 95% CI 0.25-0.94), and death (HR 0.56; 95% CI 0.36-0.87). In men with RA and ED, phosphodiesterase-5 inhibitor use was associated with a decreased risk of death (HR 0.35, 95% CI 0.16-0.79), with a trending decreased risk of some CV diagnoses. CONCLUSION Incidence of ED was not statistically increased in RA. Although patients with both RA and ED had a similar overall CV risk to those with RA alone, men with both RA and ED had decreased risk of heart failure, myocardial infarction, and death, as well as an increased risk of peripheral arterial disease. Further studies are needed to clarify these associations and their implications for pathogenesis and therapeutics.
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Affiliation(s)
- Katelynn M Wilton
- K.M. Wilton, BS, Medical Scientist Training Program, Mayo Clinic College of Medicine and Science
| | - Sara J Achenbach
- S.J. Achenbach, MS, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science
| | - John M Davis
- J.M. Davis III, MD, MS, Division of Rheumatology, Mayo Clinic College of Medicine and Science
| | - Elena Myasoedova
- E. Myasoedova, MD, PhD, E.L. Matteson, MD, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science
| | - Eric L Matteson
- E. Myasoedova, MD, PhD, E.L. Matteson, MD, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science
| | - Cynthia S Crowson
- C.S. Crowson, PhD, Division of Biomedical Statistics and Informatics, and Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.
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24
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Jin Z, Yang C, Xiao C, Wang Z, Zhang S, Ren J. Systemic lupus erythematosus and risk of sexual dysfunction: A systematic review and Meta-Analysis. Lupus 2020; 30:238-247. [PMID: 33210559 DOI: 10.1177/0961203320974081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To systematically review and summarize the available literature regarding the association between systemic lupus erythematosus (SLE) and sexual dysfunction (SD) in both sexes. METHODS We retrieved relevant studies from the following databases: PubMed, Embase,Cochrane Library, and Web of Science. Two reviewers independently reviewed the studies in our sample, assessed their validity, and extracted relevant data. Sensitivity and subgroup analyses were performed to distinguish sources of heterogeneity. RESULTS Our search resulted in a sample of eight eligible studies, which involved 758 patients in the SLE group and 1724 individuals in the control group. The pooled RR for the increased risk for SD compared to those in the control group was 1.80 (95%CI 1.12-2.87). Subgroup analysis by sex revealed that males (pooled RR = 2.98, 95%CI 2.41-3.68) had a higher risk of SD compared to females (pooled RR = 1.56, 95%CI 0.99-2.48). Females with SLE had significantly lower values in FSFI compared to the healthy individuals (WMD=-0.224, 95%CI -0.441 to -0.078). Age of participants and the quality of studies might influence the results. CONCLUSIONS Our meta-analysis suggests that SLE is significantly associated with an increased risk of sexual dysfunction. It is of great urgency to implement for active interventions that aimed to treat or prevent SD among SLE patients.
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Affiliation(s)
- Zhao Jin
- Department of internal medicine, China-Japan Friendship Hospital, Beijing, China
| | - Cong Yang
- Department of internal medicine, China-Japan Friendship Hospital, Beijing, China
| | - Chu Xiao
- Department of internal medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Zizhen Wang
- Department of internal medicine, China-Japan Friendship Hospital, Beijing, China
| | - Suxin Zhang
- Department of internal medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Jie Ren
- Department of internal medicine, Peking University Third Hospital, Beijing, China
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25
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Diack ND, Ndiaye N, Mbaye A, Kane BS, Leye A. Hypogonadotropic Hypogonadism and Juvenile Idiopathic Arthritis in an African Boy: What is the Pathophysiological Link? Cureus 2020; 12:e11337. [PMID: 33304673 PMCID: PMC7719468 DOI: 10.7759/cureus.11337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 12/02/2022] Open
Abstract
The association between hypogonadotropic hypogonadism and juvenile chronic arthritis has rarely been reported in the literature. We report an untreated case of systemic juvenile idiopathic arthritis in a young African male with co-presentation of hypogonadotropic hypogonadism. Possible pathophysiological and etiological links are discussed. A 16-year-old boy was received in our outpatient department for chronic arthritis with temporomandibular involvement and fever. There was no family history of rheumatic diseases or psoriasis. Body temperature was 39.5°C at admission. The clinical examination found synovitis of wrists and knees and inflammatory lymphadenopathy. This polyarthritis occurred in a context of hypogonadism marked by impuberism of Tanner classification stage P2G2. Laboratory tests showed biological inflammatory syndrome and hyperferritinemia with collapsed glycosylated ferritin at 11%. Hormonal testing found low blood testosterone (0.08 mg/L) and pituitary hormone levels attesting to hypogonadotropic hypogonadism. Screening for infections was negative. The immunological assessment for antinuclear antibodies, rheumatoid factor, and anti-cyclic citrullinated peptide antibodies were negative. Standard radiography showed bilateral wrist carpitis. The olfactory bulb was present and normal by cerebral magnetic resonance imaging. The diagnosis of systemic juvenile idiopathic arthritis associated with hypogonadotropic hypogonadism, probably related to delayed puberty, was retained. A therapy combining corticosteroid, methotrexate for arthritis, and hormone replacement with testosterone led to regression of arthritis, biological inflammatory syndrome, and hypogonadism. The presence of rheumatic disease in this context of hypogonadism, regardless of its cause, is mainly associated with very low testosterone levels and the presentation of arthritis in these patients tends to be more severe.
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Affiliation(s)
- Ngoné Diaba Diack
- Internal Medicine and Endocrinology, Pikine Teaching Hospital, Dakar, SEN
| | - Nafy Ndiaye
- Internal Medicine and Endocrinology, Pikine Teaching Hospital, Dakar, SEN
| | - Aminata Mbaye
- Diagnostic Radiology, Aristide Le Dantec Teaching Hospital, Dakar, SEN
| | - Baidy Sy Kane
- Internal Medicine, Aristide Le Dantec Teaching Hospital/Cheikh Anta Diop University, Dakar, SEN
| | - Abdoulaye Leye
- Internal Medicine and Endocrinology, Pikine Teaching Hospital, Dakar, SEN
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26
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Wilton KM, Achenbach SJ, Karmacharya P, Ernste FC, Matteson EL, Crowson CS. Erectile Dysfunction in Men With Psoriatic Arthritis: A Population-based Cohort Study. J Rheumatol 2020; 48:527-532. [PMID: 33060322 DOI: 10.3899/jrheum.200903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To define the incidence of erectile dysfunction (ED) in a population-based cohort of men with psoriatic arthritis (PsA). METHODS Data pertaining to demographics, ED, and potential confounding diagnosis were extracted from a comprehensive medical record system for a population-based cohort of men with PsA and an age-matched male comparator cohort. Cumulative incidence of ED adjusted for competing risk of death was compared between the 2 cohorts. RESULTS There were 128 age-matched pairs of men with PsA and without PsA in the described cohorts. At baseline, there was a 7% prevalence of ED in men with PsA prior to diagnosis compared to a 3% prevalence of ED in the comparator cohort (P = 0.16). After PsA diagnosis/index date, diagnosis with PsA was associated with an increased risk of ED (age-adjusted HR 1.45, 95% CI 0.79-2.68), but this association did not reach statistical significance. This was based on 24 cases of ED in the men with PsA and 18 cases within the comparator cohort. No confounding factors or ED treatment strategies differed significantly between men with PsA and ED and comparators with ED. CONCLUSION Men with PsA may have an increased risk of ED, which was detected but likely underpowered in this study. Whether this difference is secondary to higher prevalence of traditional risk factors of ED in men with PsA compared to the general population will require further study.
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Affiliation(s)
- Katelynn M Wilton
- K.M. Wilton, BS, Medical Scientist Training Program, Mayo Clinic College of Medicine and Science
| | - Sara J Achenbach
- S.J. Achenbach, MS, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science
| | - Paras Karmacharya
- P. Karmacharya, MBBS, F.C. Ernste, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science
| | - Floranne C Ernste
- P. Karmacharya, MBBS, F.C. Ernste, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science
| | - Eric L Matteson
- E.L. Matteson, MD, MPH, Division of Rheumatology, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science
| | - Cynthia S Crowson
- C.S. Crowson, PhD, Division of Biomedical Statistics and Informatics, and Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.
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Yu B, Darves-Bornoz AL, Brannigan RE, Halpern JA. Acute anejaculation, hypogonadism, and fertility preservation in the setting of neurosarcoidosis: case report and literature review. F S Rep 2020; 1:317-325. [PMID: 34223263 PMCID: PMC8244293 DOI: 10.1016/j.xfre.2020.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/23/2020] [Accepted: 09/26/2020] [Indexed: 11/26/2022] Open
Abstract
Objective To examine fertility preservation techniques in the setting of neurosarcoidosis, and to review the impact of corticosteroid and methotrexate therapy on fertility. Design Case report of a patient with infertility secondary to anejaculation associated with spinal neurosarcoidosis, treated with systemic corticosteroids and methotrexate. Setting Academic tertiary-care hospital. Patient(s) A 39-year-old man presented with neurosarcoidosis complicated by acute anejaculation, erectile dysfunction, and hypogonadism. He underwent fertility consultation and sperm cryopreservation before initiating methotrexate therapy. His pretreatment total testosterone was low, at 157 ng/dL. Intervention(s) Unsuccessful pharmacologic therapy and penile vibratory stimulation (PVS) were followed by microdissection testicular sperm extraction (microTESE). Clomiphene was administered for optimization of spermatogenesis before microTESE. Main Outcome Measure(s) Vials of cryopreserved sperm, testis histopathology, and serum testosterone levels. Result(s) Eight vials of viable sperm were harvested by means of micro-TESE and cryopreserved. Despite intraoperative appearance of hypospermatogenesis, 90% of seminiferous tubules had active germ cell sloughing. Total testosterone increased to 278 ng/dL 2 months after initiating clomiphene. Conclusion(s) Conventional fertility preservation techniques may be effective in the setting of neurosarcoidosis-induced infertility owing to largely intact spermatogenesis. PVS, though not effective for this patient, should be considered along with electroejaculation, given high success rates in other patients with neurogenic anejaculation. Corticosteroid-mediated hypogonadism also must be considered in these patients, because it can negatively affect downstream spermatogenesis. In addition, evidence for the impact of paternal methotrexate exposure on fertility is limited and requires further investigation. As such, fertility consultation before initiating methotrexate is highly recommended.
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Affiliation(s)
- Benjamin Yu
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anne L Darves-Bornoz
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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28
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Bay LT, Graugaard C, Nielsen DS, Möller S, Ellingsen T, Giraldi A. Sexual Health and Dysfunction in Patients With Rheumatoid Arthritis: A Cross-sectional Single-Center Study. Sex Med 2020; 8:615-630. [PMID: 32912833 PMCID: PMC7691882 DOI: 10.1016/j.esxm.2020.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/26/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction An increased risk of sexual health problems is seen among patients with chronic illnesses. The background is likely to be multifactorial, but it remains poorly understood. Aim To investigate the sexual health and functioning of patients with rheumatoid arthritis (RA) and to examine gender differences, general population comparisons, and possible somatic, psychological, and disease-specific determinants. Methods A cross-sectional study using a digital questionnaire distributed among 380 patients diagnosed with RA in a Danish university hospital outpatient setting. Main Outcome Measure A range of patient-reported outcomes were obtained, including scores from the validated rating scale Changes in Sexual Functioning Questionnaire. Furthermore, individual medical record information was collected. Results A total of 329 patients (250 women and 79 men) were included (age range: 25–73 years; mean age: 57.2 years). The Changes in Sexual Functioning Questionnaire scoring indicated an overall sexual dysfunction in 33.8% of men and 58.1% of women.More than one-third (37.6%) of patients felt that RA had made their sex life more complicated, and 32.4% feared that this might someday be the case. In total, 29.2% patients had experienced sexual problems due to their RA treatment. Of the respondents who experienced RA-related fatigue, 46.5% reported that this impacted negatively on their sexual activity. The risk of one or more sexual health adversities was significantly correlated with female gender, older age, moderate or severe depression, moderate to moderately high loneliness, more than 2 comorbidities, and a fatigue score above 75 out of 100 on a visual analogue scale. Compared to the general population, significantly fewer patients with RA considered their sex life important, and significantly fewer patients appraised their current sex life as good or very good. Moreover, significantly more women with RA (32.1%) than women from the general population (15.7%) had not had any sex life during the past year. A vast majority of patients with RA (93.5% of women and 85.5% of men) had not discussed sexual issues with a health-care professional during the last 5 years. Of all, 32.5% would like health-care professionals to address sexual topics in the consultation occasionally. Conclusion Sexual dysfunction is highly prevalent in patients with RA, but the problems are not regularly addressed in consultations provided by the rheumatology department. Bay LT, Graugaard C, Nielsen DS, et al. Sexual Health and Dysfunction in Patients With Rheumatoid Arthritis: A Cross-sectional Single-Center Study. Sex Med 2020;8:615–630.
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Affiliation(s)
- Laila Twisttmann Bay
- Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital & University of Southern Denmark, Odense, Denmark.
| | - Christian Graugaard
- Center for Sexology Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Dorthe S Nielsen
- Department of Health Research, University College Lillebaelt, Odense, Denmark; Migrant Health Clinic, Odense University Hospital, Odense, Denmark; Center for Global Health, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- OPEN, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | - Torkell Ellingsen
- Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | - Annamaria Giraldi
- Sexological Clinic, Psychiatric Centre Copenhagen, Denmark & Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Perez-Garcia LF, Dolhain R, Te Winkel B, Carrizales JP, Bramer WM, Vorstenbosch S, van Puijenbroek E, Hazes M, van Doorn MBA. Male Sexual Health and Reproduction in Cutaneous Immune-Mediated Diseases: A Systematic Review. Sex Med Rev 2020; 9:423-433. [PMID: 32883623 DOI: 10.1016/j.sxmr.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Information about the possible effects of cutaneous immune-mediated diseases (cIMDs) on male sexual function and reproduction is scarce. Factors known to impair sexual health and reproduction, such as inflammation, medication use, and hypogonadism, can be present in a significant proportion of male patients with cIMD. OBJECTIVES To systematically review the literature for the influence of paternal cIMD on many aspects of male sexual and reproductive health, such as sexual function, reproductive hormones, fertility, and pregnancy and offspring outcomes. METHODS A systematic literature search was performed. The searches combined keywords regarding male sexual function and fertility, pregnancy outcomes, and offspring's health with a list of cIMDs. RESULTS The majority of the identified studies included patients with psoriasis (22 of 27), and sexual function was the most common outcome of interest (20 of 27). For patients diagnosed with psoriasis, the prevalence of male sexual dysfunction reported in these studies ranged from 34 to 81%. Hypogonadism in patients with psoriasis was reported in 2 of 3 studies. Sperm analysis abnormalities in patients with psoriasis were reported in 3 of 4 studies. No information about the effect of paternal disease on pregnancy and offspring outcomes was identified. CONCLUSIONS Disease activity in psoriasis might play an important role in the development of sexual dysfunction, hypogonadism, and abnormal sperm quality. For the other cIMD included in this review, there is insufficient information regarding male sexual and reproductive health to draw firm conclusions. More research is needed to understand the association between cIMD and impaired male sexual and reproductive health. Perez-Garcia LF, Dolhain R, te Winkel B, et al. Male Sexual Health and Reproduction in Cutaneous Immune-Mediated Diseases: A Systematic Review. Sex Med Rev 2021;9:423-433.
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Affiliation(s)
- Luis F Perez-Garcia
- Department of Rheumatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - Radboud Dolhain
- Department of Rheumatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Bernke Te Winkel
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, the Netherlands
| | - Juan P Carrizales
- Servicio de Reumatología, Universidad Autónoma de Nuevo León, Hospital Universitario, Monterrey, Mexico
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Saskia Vorstenbosch
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, the Netherlands
| | - Eugene van Puijenbroek
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, the Netherlands; Research Institute of Pharmacy, PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, the Netherlands
| | - Mieke Hazes
- Department of Rheumatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Martijn B A van Doorn
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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De Cock D, Brants L, Soenen I, Pazmino S, Bertrand D, Stouten V, Westhovens R, Verschueren P. A systematic review on the effect of DMARDs on fertility in rheumatoid arthritis. Semin Arthritis Rheum 2020; 50:873-878. [PMID: 32896703 DOI: 10.1016/j.semarthrit.2020.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Drug therapy could alter fertility in patients with rheumatoid arthritis (RA). We aimed to perform a systematic review to evaluate if Disease-modifying antirheumatic drug (DMARD) therapy influences fertility as this is an important point to consider in shared decision making on RA therapy. METHODS A search was conducted at 18/10/2019 in EMBASE, PubMed (including MEDLINE) and the Web of Science Core Collection. Our inclusion criteria were studies involving women or men diagnosed with RA, older than 18 years and on DMARD therapy, with as outcome a fertility parameter. Systematic reviews, meta-analyses, case reports, case series and animal studies were excluded. Studies not in English or Dutch or published before 2004 were excluded. Quality appraisal was performed by the CASP systematic review checklist. RESULTS After duplicate removal, 9030 references were identified. After title/abstract screening, 82 articles remained. After full text screening, 4 articles could be retained. No studies were found through backward snowballing. Only studies involving women could be retained. The included studies investigated the effect of methotrexate, certolizumab pegol, etanercept and sulfasalazine on fertility. No detrimental effects of these DMARDs on time-to-pregnancy, anti-Müllerian hormone serum level or presence of a history of infertility, were reported. CONCLUSION This systematic review underlines the gap in knowledge regarding the effect of DMARDs on fertility in women and especially men with RA. DMARD treatment, contrary to general belief, seemed to have no harmful effect on fertility, possibly because it resulted in better controlled disease activity. More research is needed to improve guidance for patients with RA with a child wish.
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Affiliation(s)
- D De Cock
- Skeletal Biology and Engineering Research Centre, KU Leuven, Herestraat, Leuven 49 3000, Belgium.
| | - L Brants
- Skeletal Biology and Engineering Research Centre, KU Leuven, Herestraat, Leuven 49 3000, Belgium
| | - I Soenen
- Skeletal Biology and Engineering Research Centre, KU Leuven, Herestraat, Leuven 49 3000, Belgium
| | - S Pazmino
- Skeletal Biology and Engineering Research Centre, KU Leuven, Herestraat, Leuven 49 3000, Belgium
| | - D Bertrand
- Skeletal Biology and Engineering Research Centre, KU Leuven, Herestraat, Leuven 49 3000, Belgium
| | - V Stouten
- Skeletal Biology and Engineering Research Centre, KU Leuven, Herestraat, Leuven 49 3000, Belgium
| | - R Westhovens
- Skeletal Biology and Engineering Research Centre, KU Leuven, Herestraat, Leuven 49 3000, Belgium; Rheumatology Department, University Hospitals Leuven, Leuven, Belgium
| | - P Verschueren
- Skeletal Biology and Engineering Research Centre, KU Leuven, Herestraat, Leuven 49 3000, Belgium; Rheumatology Department, University Hospitals Leuven, Leuven, Belgium
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