Department of Rheumatology, Basel University, Burgfelderstrasse 101, Basel 4012, Switzerland.
Arthritis Res Ther. 2012 Feb 20;14(1):R37. doi: 10.1186/ar3748.
Erectile dysfunction (ED) is common in men with systemic sclerosis (SSc) but the demographics, risk factors and treatment coverage for ED are not well known.
This study was carried out prospectively in the multinational EULAR Scleroderma Trial and Research database by amending the electronic data-entry system with the International Index of Erectile Function-5 and items related to ED risk factors and treatment. Centres participating in this EULAR Scleroderma Trial and Research substudy were asked to recruit patients consecutively.
Of the 130 men studied, only 23 (17.7%) had a normal International Index of Erectile Function-5 score. Thirty-eight per cent of all participants had severe ED (International Index of Erectile Function-5 score ≤ 7). Men with ED were significantly older than subjects without ED (54.8 years vs. 43.3 years, P < 0.001) and more frequently had simultaneous non-SSc-related risk factors such as alcohol consumption. In 82% of SSc patients, the onset of ED was after the manifestation of the first non-Raynaud's symptom (median delay 4.1 years). ED was associated with severe cutaneous, muscular or renal involvement of SSc, elevated pulmonary pressures and restrictive lung disease. ED was treated in only 27.8% of men. The most common treatment was sildenafil, whose efficacy is not established in ED of SSc patients.
Severe ED is a common and early problem in men with SSc. Physicians should address modifiable risk factors actively. More research into the pathophysiology, longitudinal development, treatment and psychosocial impact of ED is needed.
勃起功能障碍（ED）在系统性硬化症（SSc）男性中较为常见，但 ED 的人口统计学、危险因素和治疗覆盖率尚不清楚。
本研究通过在电子数据输入系统中加入国际勃起功能指数-5（IIEF-5）和与 ED 危险因素及治疗相关的项目，在多中心 EULAR 硬皮病试验和研究数据库中前瞻性开展。该 EULAR 硬皮病试验和研究子研究要求各参与中心连续招募患者。
在 130 名男性中，仅有 23 名（17.7%）的国际勃起功能指数-5 评分正常。所有参与者中有 38%存在严重 ED（国际勃起功能指数-5 评分≤7）。ED 男性比无 ED 男性年龄显著更大（54.8 岁比 43.3 岁，P<0.001），同时存在更多的非 SSc 相关危险因素，如饮酒。在 82%的 SSc 患者中，ED 发病时间晚于首发非雷诺现象症状（中位数延迟 4.1 年）。ED 与 SSc 的严重皮肤、肌肉或肾脏受累、肺动脉高压和限制性肺病相关。仅 27.8%的男性接受了 ED 治疗。最常见的治疗药物是西地那非，但西地那非在 SSc 患者 ED 中的疗效尚未确定。
严重 ED 是 SSc 男性常见且早期出现的问题。医生应积极处理可改变的危险因素。需要进一步研究 ED 的病理生理学、纵向发展、治疗和对社会心理的影响。
