Erectile dysfunction (ED) is common and often severe in men suffering from gout, according to the results of a cross-sectional survey of men who presented to a rheumatology clinic.

“These results strongly support the proposal to screen all men with gout for the presence of ED. Increasing awareness should in turn lead to earlier medical attention and treatment for this distressing condition,” said lead author Naomi Schlesinger, MD, chief, Division of Rheumatology, and professor of medicine at Rutgers–Robert Wood Johnson Medical School, in New Brunswick, New Jersey.

The results of the study were presented here at the European League Against Rheumatism (EULAR) Congress 2014.

The most common inflammatory arthritis in men older than 40 years, gout is caused by deposits of urate crystals in the joints and is associated with uricemia. The crystals cause inflammation, pain, and swelling, and the inflammatory component of the disease is linked to risk factors for cardiovascular disease and coronary artery disease.

The cross-sectional study included 201 men aged 18 to 89 years who presented at a rheumatology clinic between August 2010 and May 2013. Of these, 83 had gout.

Participants filled out a Sexual Health Inventory in Men (SHIM) questionnaire, which evaluates the ability to have an erection, the firmness of the erection, the ability to penetrate sufficiently for sexual intercourse, and sexual satisfaction. A score of ≤21 indicates ED; a score of ≤10 indicates severe ED.

“Men don’t usually volunteer sexual complaints,” said Dr. Schlesinger. “The gout patients in our study were generally delighted and grateful that someone finally asked them about ED.”

The mean SHIM score for all participants was 16.88. Patients with gout had a mean SHIM score of 14.38 compared with 18.53 in patients without gout (P < .0001).

A significantly greater percentage of patients with gout had ED compared with patients without gout (76% vs 52%, P = .0007). Also, significantly more men with gout had severe ED vs men without gout (43% vs 30%, P = .007).

The presence of ED was significantly more frequent in gout patients aged 65 years or older, compared with men of the same age without gout (P = .0001), and was significantly more likely to be severe (P = .0002).

A multivariate analysis adjusted for age, hypertension, low-density cholesterol level, glomerular filtration rate, obesity, and depression found that the association between gout and ED was statistically significant (P = .0096).

Silent Coronary Artery Disease

 “It is estimated that 1 in 5 men who present with ED have silent coronary artery disease. A man with ED, even with no cardiac symptoms, is a cardiac patient until proven otherwise,” said Dr. Schlesinger. “Perhaps we could say that the 3 ‘EDs’ are related: endothelial dysfunction leads to erectile dysfunction leads to early death.

“Gout patients who present with ED have an increased rate of cardiovascular risk factors and concomitant silent coronary artery disease and should be evaluated,” she added.

 Maya Buch, MD, from the Leeds Institute of Rheumatology and Musculoskeletal Medicine, at the University of Leeds, United Kingdom, praised the authors of this study for providing new information on these conditions with overlapping risk factor — gout and cardiovascular disease.
 “These patients are at risk for cardiomyopathies, and there is no literature on ED and gout. We know that patients with gout have multiple comorbidities, and it’s clear that rheumatologists need to address that,” she explained.

“I was surprised at how many patients with gout have ED. In addition to treating hyperuricemia in our patients with gout, we need to pay attention to cardiovascular risk factors. I hope that this study makes doctors more receptive to evaluating patients for ED,” she added.

Dr. Schlesinger has disclosed no relevant financial relationships. Dr. Buch has received honoraria and consulting fees from AbbVie, Bristol-Myers Squibb, and Roche-Chugai and has a research grant from Pfizer, Inc.

 European League Against Rheumatism (EULAR) Congress 2014: Abstract OP0135. Presented June 13, 2014.

Written By: Alice Goodman

Article Source: http://www.medscape.com/viewarticle/826773

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