Sexual dysfunction in male patients treated with methorexate for arthritis: Analysis of the IIEF5 questionnaire and hormonal status

Objective

The aim of this study is to evaluate the impact of methotrexate (MTX) on erectile function in male patients through the International Index of Erectile Function (IIEF5) questionnaire and hormonal dosage.

Methods

Male patients affected by inflammatory arthritis (rheumatoid arthritis [RA] or psoriatic arthritis [PsA]) with good disease control and treated with chronic MTX were enrolled. Age-matched patients affected by chronic arthritis not treated with MTX were enrolled as controls. Each patient had a complete sexual hormone evaluation. IIEF5 questionnaire was administered to each patient.

Results

One hundred and nine patients were included, 77 in the MTX group and 32 as controls. The median weekly MTX dose was 10 mg (IQR 7.5) with a median MTX duration therapy of 8 years (IQR 17). The total IIEF5 score was lower in patients MTX exposed compared to the control group without a significant result. The total IIEF5 score of patients treated with MTX ≥ 5 years was statistically significantly lower when compared to those non-MTX exposed patients (17 [IQR 15] versus 20 [IQR 7.7]; P = 0.04) and compared to those treated for < 5 years (17 [IQR 15] versus 20 [IQR 7]; P = 0.01). A negative correlation was identified between the total IIEF5 score and MTX time exposure (r = –0.20 CI [–0.38 to –0.04]; P = 0.039). MTX exposure was still associated with a lower IIEF5 score when adjusted for age (β Estimate = –2.63; CI [–5.13 to –0.13]; P = 0.039). Hormonal dosage was similar in both groups for all hormones evaluated.

Conclusion

MTX exposure was associated with a lower IIEF5 score in male patients adjusted for age. The preliminary results need to be confirmed in larger prospective studies.