Department of Rheumatology, Erasmus MC, University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH, 's-Hertogenbosch, the Netherlands.
Semin Arthritis Rheum. 2020 Jun;50(3):557-573. doi: 10.1016/j.semarthrit.2020.02.002. Epub 2020 Feb 14.
Information about the possible effect of rheumatic diseases on male sexual function and reproduction (sexual health) is scarce and difficult to summarize. Factors known to impair sexual health, such as inflammation, medication use and hypogonadism can be present in a significant proportion of male patients with rheumatic diseases.
The objective of our study was to systematically review the literature for the influence of paternal rheumatic disease on sexual health, such as sexual function, reproductive hormones, male fertility, pregnancy and offspring outcomes.
English language articles identified through Embase, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Google Scholar and the Clinical trial registries of Europe and the USA published until February 2019.
Literature was synthesized in narrative form and in summary tables. Outcomes were categorized as: sexual function, reproductive hormones, fertility and pregnancy and offspring outcomes. Results are presented per category and per disease.
9735 articles were identified with our search strategy. After removal of duplicates, excluding articles by screening titles and abstracts and assessing eligibility by reading 289 fulltext articles, 87 articles fulfilled the eligibility criteria. All included studies enrolled patients diagnosed with a rheumatic disease and had results at least on one of the outcome categories. Sexual function was the most common category, followed by reproductive hormones, fertility and pregnancy and offspring outcomes. Sexual function is impaired in a high proportion of patients with rheumatic diseases. This was statistically significant in most of the studies where a control group was available. Clinically relevant abnormalities in reproductive hormones were mainly identified in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) and a positive correlation with disease activity were reported. Semen quality in men with rheumatic diseases can be impaired in patients with SLE, SpA, sarcoidosis, BD and MWS. Sperm count and motility were the most common semen quality parameters affected. No negative effect of paternal RA and vasculitis on pregnancy outcomes were reported in 3 studies. No studies reporting the effect of paternal disease on offspring outcomes were identified.
Most of the studies included in this review suffer from an inconsistent methodological quality, definitions of outcomes varied in several studies, a wide variety of screening questionnaires and/or diagnostic tools were used and results might only apply to the specific populations that were studied.
This systematic review suggests that sexual health is impaired in men with rheumatic diseases. The degree and extent of sexual health impairment vary per disease. More research is needed to fully understand the link between rheumatic diseases and impaired male sexual health. Meanwhile, rheumatologists should be aware of this association and discuss it with their patients.
Sexual health of men with rheumatic diseases can be impaired by the disease itself. Especially in men trying to conceive, information on sexual function, reproductive hormones and sperm quality are needed to identify these problems. Treatment resulting in lower disease activity can improve overall sexual health in man with rheumatic diseases and facilitate their journey to fatherhood.
PROSPERO 2018 CRD42018099845.
关于风湿性疾病对男性性功能和生殖（性健康）影响的信息很少，难以总结。已知会损害性健康的因素，如炎症、药物使用和性腺功能减退症，可能存在于相当一部分患有风湿性疾病的男性患者中。
我们的研究旨在系统地回顾文献，以了解父亲患风湿性疾病对性功能、生殖激素、男性生育能力、妊娠和后代结局的影响。
通过 Embase、MEDLINE、Cochrane 中央对照试验注册库（CENTRAL）、Web of Science、Google Scholar 以及美国和欧洲的临床试验注册库，以英文发表的文章，检索截至 2019 年 2 月的文献。
文献以叙述形式和汇总表形式综合。结果分为：性功能、生殖激素、生育能力和妊娠及后代结局。按疾病类别和类别进行呈现。
通过我们的搜索策略，共确定了 9735 篇文章。在去除重复项、排除通过筛选标题和摘要以及阅读 289 篇全文文章来排除不符合条件的文章，并通过阅读 289 篇全文文章来评估合格性后，有 87 篇文章符合纳入标准。所有纳入的研究均招募了诊断为风湿性疾病的患者，并至少在一个结果类别中获得了结果。性功能是最常见的类别，其次是生殖激素、生育能力和妊娠及后代结局。性功能受损在很大比例的风湿性疾病患者中很常见。在有对照组的大多数研究中，这具有统计学意义。临床上与疾病活动相关的生殖激素异常主要发生在类风湿关节炎（RA）和系统性红斑狼疮（SLE）患者中，并报告了与疾病活动的正相关。患有 SLE、SpA、结节病、BD 和 MWS 的风湿性疾病男性的精液质量可能受损。精子计数和活力是最常见受影响的精液质量参数。有 3 项研究未报告父亲患 RA 和脉管炎对妊娠结局的负面影响。没有研究报告父亲疾病对后代结局的影响。
本综述中纳入的大多数研究存在方法学质量不一致的问题，一些研究中对结果的定义各不相同，使用了各种筛查问卷和/或诊断工具，并且结果可能仅适用于研究的特定人群。
本系统评价表明，风湿性疾病男性的性健康受损。性功能障碍的程度和范围因疾病而异。需要进一步的研究来充分了解风湿性疾病与受损男性性健康之间的联系。同时，风湿病学家应该意识到这种关联，并与他们的患者讨论。
风湿性疾病男性的性健康可能因疾病本身而受损。特别是在试图怀孕的男性中，需要了解性功能、生殖激素和精子质量方面的信息，以识别这些问题。导致疾病活动度降低的治疗可以改善风湿性疾病男性的整体性健康，并促进他们成为父亲的旅程。
PROSPERO 2018 CRD42018099845。
