Impact of ankylosing spondylitis on sexual function: A systematic review and meta‑analysis

Liu,Ya‑Fei; Dong,Hui; Chen,Zhe; Wang,Yu; Tu,Sheng‑Hao

doi:10.3892/etm.2015.2239

Impact of ankylosing spondylitis on sexual function: A systematic review and meta‑analysis

Authors:
- Ya‑Fei Liu
- Hui Dong
- Zhe Chen
- Yu Wang
- Sheng‑Hao Tu
View Affiliations

Affiliations: Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
Published online on: January 29, 2015 https://doi.org/10.3892/etm.2015.2239
Pages: 1501-1507

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

A number of studies have reported the association of sexual problems with ankylosing spondylitis (AS); however, the results have been conflicting. The present study aimed to investigate the impact of AS on sexual function. To develop a more comprehensive understanding of sexual function in patients with AS, a systematic review and meta‑analysis of the literature up to 2013 was conducted. Studies that assessed the impact of AS on sexual function by adopting the International Index of Erectile Function or the Female Sexual Function Index (FSFI) scoring system were included. Statistical analysis was performed using Review Manager statistical software (version 5.2). The weighted mean differences were calculated by employing a fixed or random effects model. A total of 484 cases from five studies were identified as being well‑documented and included in the meta‑analysis. Compared with healthy controls, male patients with AS have a significant reduction in sexual function scores of erectile function (-3.07), orgasmic function (-1.17), sexual drive (-0.72) and intercourse satisfaction (-1.89). Female patients with AS have a lower FSFI score in domains of desire (-0.34) and arousal (-0.87). In conclusion, AS has a certain impact on the sexual function of male patients. AS appears to have a greater influence on the sexual function of males compared with that of females. However, the mechanism by which AS affects sexual function requires further evaluation by further studies of a larger population of patients.

View Figures

View References

1	Braun J and Sieper J: Ankylosing spondylitis. Lancet. 369:1379–1390. 2007. View Article : Google Scholar : PubMed/NCBI
2	Keat A: Sex and the spondylitic. Rheumatology (Oxford). 48:1337–1338. 2009. View Article : Google Scholar
3	Ozgül A, Peker F, Taskaynatan MA, et al: Effect of ankylosing spondylitis on health-related quality of life and different aspects of social life in young patients. Clin Rheumatol. 25:168–174. 2006. View Article : Google Scholar
4	Hill J, Bird H and Thorpe R: Effects of rheumatoid arthritis on sexual activity and relationships. Rheumatology (Oxford). 42:280–286. 2003. View Article : Google Scholar
5	Tristano AG: The impact of rheumatic diseases on sexual function. Rheumatol Int. 29:853–860. 2009. View Article : Google Scholar : PubMed/NCBI
6	Gordon D, Beastall GH, Thomson JA and Sturrock RD: Androgenic status and sexual function in males with rheumatoid arthritis and ankylosing spondylitis. Q J Med. 60:671–679. 1986.PubMed/NCBI
7	Chung SD, Chen YK, Kang JH, Keller JJ, Huang CC and Lin HC: Population-based estimates of medical comorbidities in erectile dysfunction in a Taiwanese population. J Sex Med. 8:3316–3324. 2011. View Article : Google Scholar : PubMed/NCBI
8	Chung SD, Chen YK, Liu SP and Lin HC: Association between ED in ankylosing spondylitis: a population-based study. Int J Impot Res. 25:229–233. 2013. View Article : Google Scholar : PubMed/NCBI
9	Bal S, Bal K, Turan Y, Deniz G, Gürgan A, Berkit IK and Sendur OF: Sexual functions in ankylosing spondylitis. Rheumatol Int. 31:889–894. 2011. View Article : Google Scholar
10	Moher D, Liberati A, Tetzlaff J and Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 151:264–269. 2009. View Article : Google Scholar : PubMed/NCBI
11	Stroup DF, Berlin JA, Morton SC, et al: Meta-analysis of observational studies in epidemiology: a propoal for reporting. Meta-analysis of observational studies in Epidemiology (MOOSE) group. JAMA. 283:2008–2012. 2000. View Article : Google Scholar : PubMed/NCBI
12	van der Linden S, Valkenburg HA and Cats A: Evaluation of diagonstic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 27:361–368. 1984. View Article : Google Scholar : PubMed/NCBI
13	Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J and Mishra A: The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 49:822–830. 1997. View Article : Google Scholar : PubMed/NCBI
14	Rosen R, Brown C, Heiman J, et al: The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 26:191–208. 2000. View Article : Google Scholar : PubMed/NCBI
15	Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M and Tugwell P: The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Health Research Institute; 2000
16	Mahid SS, Minor KS, Soto RE, Hornung CA and Galandiuk S: Smoking and inflammatory bowel disease: a meta-analysis. Mayo Clin Proc. 81:1462–1471. 2006. View Article : Google Scholar : PubMed/NCBI
17	Rezvani A, Ök Ş and Demir SE: Assessment of sexual functions in male patients with ankylosing spondylitis compared with healthy controls. Turk J Rheumatol. 27:233–240. 2012.
18	Pirildar T, Müezzinoğlu T and Pirildar S: Sexual function in ankylosing spondylitis: a study of 65 men. J Urol. 171:1598–1600. 2004. View Article : Google Scholar : PubMed/NCBI
19	Sariyildiz MA, Batmaz I, Dilek B, et al: Relationship of the sexual functions with the clinical parameters, radiological scores and the quality of life in male patients with ankylosing spondylitis. Rheumatol Int. 33:623–629. 2013. View Article : Google Scholar
20	Demir SE, Rezvani A and Ok S: Assessment of sexual functions in female patients with ankylosing spondylitis compared with healthy controls. Rheumatol Int. 33:57–63. 2013. View Article : Google Scholar
21	Sariyildiz MA, Batmaz I, Inanir A, et al: The impact of ankylosing spondylitis on female sexual functions. Int J Impot Res. 25:104–108. 2013. View Article : Google Scholar : PubMed/NCBI
22	Feldtkeller E, Khan M, van der Heijde D, van der Linden S and Braun J: Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int. 23:61–66. 2003.PubMed/NCBI
23	van der Linden SM, Valkenburg HA, de Jongh BM and Cats A: The risk of developing ankylosing spondylitis in HLA-B27 positive individuals. A comparison of relatives of spondylitis patients with the general population. Arthritis Rheum. 27:241–249. 1984. View Article : Google Scholar : PubMed/NCBI
24	van der Horst-Bruinsma IE, Zack DJ, Szumski A and Koenig AS: Female patients with ankylosing spondylitis: analysis of the impact of gender across treatment studies. Ann Rheum Dis. 72:1221–1224. 2013. View Article : Google Scholar
25	Lee W, Reveille JD, Davis JC Jr, Learch TJ, Ward MM and Weisman MH: Are there gender differences in severity of ankylosing spondylitis? Results from the PSOAS cohort. Ann Rheum Dis. 66:633–638. 2007. View Article : Google Scholar
26	Elst P, Sybesma T, van der Stadt RJ, Prins AP, Muller WH and den Butter A: Sexual problems in rheumatoid arthritis and ankylosing spondylitis. Arthritis Rheum. 27:217–220. 1984. View Article : Google Scholar : PubMed/NCBI
27	Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C, Moreira E and Wang T; GSSAB Investigators’ Group. Sexual problems among women and men aged 40–80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res. 17:39–57. 2004. View Article : Google Scholar
28	Basson R, Berman J, Burnett A, et al: Report of the international consensus development conference on female sexual dysfunction: definitions and classifications. J Urol. 163:888–893. 2000. View Article : Google Scholar : PubMed/NCBI
29	Basson R, Leiblum S, Brotto L, et al: Definitions of women’s sexual dysfunction reconsidered: advocating expansion and revision. J Psychosom Obstet Gynaecol. 24:221–229. 2003. View Article : Google Scholar
30	Gratacós J, Collado A, Filella X, et al: Serum cytokines (IL-6, TNF-α, IL-1β and IFN-γ) in ankylosing spondylitis: a close correlation between serum IL-6 and disease activity and severity. Br J Rheumatol. 33:927–931. 1994. View Article : Google Scholar
31	Braun J, Bollow M, Neure L, et al: Use of immunohistologic and in situ hybridization techniques in the examination of sacroiliac joint biopsy specimens from patients with ankylosing spondylitis. Arthritis Rheum. 38:499–505. 1995. View Article : Google Scholar : PubMed/NCBI
32	Carneiro FS, Webb RC and Tostes RC: Emerging role for TNF-α in erectile dysfunction. J Sex Med. 7:3823–3834. 2010. View Article : Google Scholar : PubMed/NCBI
33	Oh JS, Heo HM, Kim YG, Lee SG, Lee CK and Yoo B: The effect of anti-tumor necrosis factor agents on sexual dysfunction in male patients with ankylosing spondylitis: a pilot study. Int J Impot Res. 21:372–375. 2009. View Article : Google Scholar : PubMed/NCBI
34	Cakar E, Dincer U, Kiralp MZ, et al: Sexual problems in male ankylosing spondylitis patients: relationship with functionality, disease activity, quality of life and emotional status. Clin Rheumatol. 26:1607–1613. 2007. View Article : Google Scholar : PubMed/NCBI
35	Dincer U, Cakar E, Kiralp MZ and Dursun H: Assessment of sexual dysfunction in male patients with ankylosing spondylitis. Rheumatol Int. 27:561–566. 2007. View Article : Google Scholar
36	Healey EL, Haywood KL, Jordan KP, Garratt AM, Ryan S and Packham JC: Ankylosing spondylitis and its impact on sexual relationships. Rheumatology. 48:1378–1381. 2009. View Article : Google Scholar : PubMed/NCBI
37	Shen B, Zhang A, Liu J, Da Z, Xu X and Gu Z: A primary analysis of sexual problems in Chinese patients with ankylosing spondylitis. Rheumatol Int. 33:1429–1435. 2013. View Article : Google Scholar
38	Wylie G, Evans CD and Gupta G: Reduced libido and erectile dysfunction: rarely reported side-effects of methotrexate. Clin Exp Dermatol. 34:e2342009. View Article : Google Scholar : PubMed/NCBI
39	Aguirre MA, Vélez A, Romero M and Collantes E: Gynecomastia and sexual impotence associated with methotrexate treatment. J Rheumatol. 29:1793–1794. 2002.PubMed/NCBI
40	Thomas E, Koumouvi K and Blotman F: Impotence in a patient with rheumatoid arthritis treated with methotrexate. J Rheumatol. 27:1821–1822. 2000.PubMed/NCBI