Sexuality and sexual dysfunction in patients with psoriatic arthritis: A cross-sectional study.

OBJECTIVE: Psoriatic arthritis (PsA) is a chronic inflammatory disorder affecting the joints, skin and entheses. Despite the importance of the topic, few studies have investigated the association between PsA and sexual function. The purpose of this study was to assess sexuality and the prevalence of sexual dysfunction (SD) in patients with PsA. METHODS: This was an observational, cross-sectional single-center study on 23 PsA patients (male=12; female=11) evaluated with 2 male questionnaires (MSQ= Male Sexual Quotient, and IIEF=International Index of Erectile Function) and 2 female questionnaires (FSQ= Female Sexual Quotient, and FSFI=Female Sexual Function Index) validated for Brazilian Portuguese, in order to determine changes in sexual function. Clinical parameters, musculoskeletal activity and skin activity were also analyzed to identify factors associated with SD. RESULTS: The mean age was 52.1±9.7 years (males) and 49.1±9.6 years (females). Clinically, the patients had low skin and peripheral joint disease activity or were in remission. The mean time of PsA was 10±6.2 years, and 65.2% had a steady sexual partner. The mean MSQ score was 75.8±16.8. The prevalence of SD was 91.7% in men (IIEF), with a predominance of mild SD. The mean FSQ score was 64.9±24.1. The prevalence of SD was 72.7% in women (FSFI), with low domain scores. Also, a significant association was found between female age and total and domain-specific FSFI scores. PASI (Psoriasis Area and Severity Index) and the general satisfaction domain (IIEF) were significantly correlated. CONCLUSION: This study found a high prevalence of SD in PsA patients. Age had a negative impact on female sexual function. Physicians need to be more aware of SD in this population to provide early multidisciplinary treatment and minimize the impact of the disease on the quality of life of patients and their partners.

Position statement of the Brazilian society of Rheumatology on mesna use as a preventive therapy for bladder disease in patients with systemic autoimmune diseases and systemic vasculitis under cyclophosphamide treatment.

OBJECTIVE: To review current literature to support the use of mesna as a preventive therapy for hemorrhagic cystitis and bladder cancer in patients with systemic autoimmune diseases and systemic vasculitis treated with cyclophosphamide. MATERIALS AND METHODS: The search for articles was conducted systematically through MEDLINE, LILACS, Cochrane Library, and Embase databases. Only articles in English were selected. For available records, titles and abstracts were selected independently by two investigators. RESULTS: Eighteen studies were selected for analysis. The known adverse effects of cyclophosphamide were hematological toxicity, infections, gonadal toxicity, teratogenicity, increased risk for malignancy and hemorrhagic cystitis. Long-term toxicity was highly dependent on cyclophosphamide cumulative dose. The risk of bladder cancer is especially higher in long-term exposure and with cumulative doses above 36 g. The risk remains high for years after drug discontinuation. Hemorrhagic cystitis is highly correlated with cumulative dose and its incidence ranges between 12 and 41%, but it seems to be lower with new regimens with reduced cyclophosphamide dose. No randomized controlled trials were found to analyze the use of mesna in systemic autoimmune rheumatic diseases and systemic vasculitis. Retrospective studies yielded conflicting results. Uncontrolled prospective studies with positive results were considered at high risk of bias. No evidence was found to support the use of mesna during the treatment with cyclophosphamide for autoimmune diseases or systemic vasculitis to prevent hemorrhagic cystitis and bladder cancer. In the scenarios of high cumulative cyclophosphamide dose (i.e., > 30 g), patients with restricted fluid intake, neurogenic bladder, therapy with oral anticoagulants, and chronic kidney disease, mesna could be considered. CONCLUSION: The current evidence was found to be insufficient to support the routine use of mesna for the prophylaxis of hemorrhagic cystitis and bladder cancer in patients being treated for systemic autoimmune diseases and systemic vasculitis with cyclophosphamide. The use may be considered for selected cases.

Redução da reserva ovariana em pacientes com artrite de Takayasu / Reserve reduction of ovarian in patients of Takayasu arteriti

Objetivo: Avaliar marcadores de reserva ovariana e a presença de anticorpo anti-corpo lúteo (anti-CoL) em pacientes com arterite de Takayasu (AT) e possível associação com parâmetros clínicos, laboratoriais e uso de imunossupressores. Métodos: 20 pacientes com AT e 24 controles saudáveis foram avaliados para anti-CoL (immunoblot). A reserva ovariana foi avaliada por: hormônio folículo estimulante (FSH), hormônio luteinizante (LH), estradiol, hormônio anti-Mülleriano (HAM) e contagem de folículos antrais (CFA). HAM foi dosado por ELISA utilizando dois diferentes testes. Dados demográficos, obstétricos, alterações menstruais, aspectos clínicos, imagens vasculares e tratamento foram também analisados. Resultados: A média da idade atual foi similar em pacientes e controles (31,2 ± 6,1 vs. 30,4 ± 6,9 anos, p = 0,69). As frequências de HAM baixo foram idênticas em pacientes com AT com ambos os testes de ELISA e maiores quando comparadas ao grupo controle (50% vs.17%, p=0,02, 50% vs. 19%, p=0,048). Observou-se uma correlação positiva entre os dois testes de ELISA em pacientes (r=0,93, p < 0,0001) e em controles saudáveis (r=0,93, p < 0,0001). Pacientes com AT apresentaram menor CFA (11 vs. 16, p=0,13) e maior frequência de CFA reduzida (41% vs. 22%, p=0,29), contudo sem significância estatística. Não foram encontradas diferenças entre os dois grupos em relação às outras características demográficas e clínicas, dados obstétricos e demais parâmetros da reserva ovariana (p > 0,05). Anti-CoL foi observado apenas em uma paciente com AT (5% vs. 0%, p = 0,45). Avaliação adicional das mulheres com AT comparando as com baixos níveis de HAM ( < 1,0 ng/mL) versus aquelas com níveis de HAM QRUPD ng/mL) não mostrou diferença entre os dois grupos em relação a duração da doença, atividade de doença, provas de fase aguda, exames de imagem vascular e tratamento (p > 0,05). Conclusão: O presente estudo foi o primeiro a sugerir que as pacientes com AT podem...

Objective: To assess ovarian reserve markers and anti-corpus luteum antibodies (anti-CoL) in Takayasu arteritis (TA) patients and a possible association with clinical and laboratory parameters and the use of immunosuppressive drugs. Methods: 20 TA and 24 healthy controls were evaluated for anti-CoL (immunoblot). Ovarian reserve was assessed by: follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, antiMüllerian hormone (AMH) and antral follicle count (AFC). AMH was measured by ELISA using two different kits. Demographical data, menstrual abnormalities, obstetric data, clinical features, vascular imaging and treatment were also analyzed. Results: The mean current age was similar in TA patients and controls (31.2 6.1 vs. 30.4 6.9 years, p=0.69). The frequencies of decreased levels of AMH in TA patients were identical using both kits and higher when compared to controls (50% vs. 17%, p=0.02; 50% vs. 19%, p=0.048). A positive correlation was observed between the two kits in TA patients (r=+0.93; p < 0.0001) and in healthy controls (r=+0.93; p < 0.0001). The apparent lower AFC (11 vs. 16, p=0.13) and the higher frequency of low AFC (41% vs. 22%, p=0.29) in TA compared to controls did not reach statistical significance. No differences between the two groups were found concerning other demographic and clinical characteristics, obstetric data and other parameters of ovarian reserve (p > 0.05). Anti-CoL was solely observed in TA patients (5% vs. 0%, p=0.45). Further evaluation of TA patients comparing patients with low AMH levels ( < 1.0ng/mL) versus normal AMH levels (.- 1.0ng/mL) revelead no differences regarding disease duration, disease activity, acute phase reactants, vascular imaging and treatment between these two groups (p > 0.05). Conclusions: The present study was the first to suggest that TA patients may have diminished ovarian reserve.

Características da arterite de Takayasu no início da doença e de acordo com o gênero / Features of the onset of Takayasu's arteritis acccording to gender

FUNDAMENTO: Embora haja diversos estudos epidemiológicos publicados referentes à artrite de Takayasu (AT), nenhum analisou a influência do gênero nas manifestações clínicas e laboratoriais ou as alterações vasculares no início da doença. OBJETIVO: Analisar a influência do gênero nas manifestações clínicas e laboratoriais e nas variações de imagiologia vascular no início da AT. MÉTODOS: Estudo de coorte retrospectivo, unicêntrico que avaliou 55 pacientes consecutivos com AT entre 1982 e 2012. Todos os dados clínicos e resultados de testes laboratoriais relacionados ao início da doença foram analisados. Incluímos apenas pacientes de 12 a 35 anos no diagnóstico para excluir fatores relacionados à idade. RESULTADOS: Analisamos 17 homens e 38 mulheres, sendo a maioria caucasiana, com uma média de idade comparável entre os gêneros. Não houve diferença de gênero referente às características clínicas ou laboratoriais, comorbidades ou tabagismo, exceto pela dor abdominal, que apresentou ser mais comum em homens. Com relação às lesões vasculares, a presença de aneurismas da aorta ascendente foi significativamente mais frequente em homens. O gênero masculino representou um fator de risco independente para a ocorrência de dor abdominal e aneurismas da aorta ascendente em pacientes com AT. CONCLUSÃO: A dor abdominal e aneurismas da aorta ascendente ocorreram com mais frequência em homens com AT, sugerindo um perfil de doença mais severa em homens.

BACKGROUND: Although there are various published epidemiological studies regarding Takayasu's arteritis (TA), none have analyzed the influence of gender on the clinical and laboratory manifestations or vascular alterations at disease onset. OBJECTIVES: To analyze the influence of gender on clinical and laboratory manifestations and variations in vascular imaging at TA onset. METHODS: A retrospective, unicentric cohort study that evaluated 55 consecutive TA patients between 1982 and 2012. All available clinical data and laboratory test results related to the onset of the disease were analyzed. We included only patients aged 12-35 years at diagnosis to exclude age-related factors. RESULTS: We analyzed 17 men and 38 women, mostly Caucasian, with a comparable mean age between genders. There was no gender difference regarding the clinical or laboratory characteristics, comorbidities, or smoking habit, except for abdominal pain, which was more common in men. Regarding vascular lesions, the presence of ascending aortic aneurysms was significantly more frequent in males. Male gender represented an independent risk factor for the occurrence of abdominal pain and ascending aortic aneurysms in TA patients. CONCLUSION: Abdominal pain and ascending aortic aneurysms occurred more frequently in men with TA, suggesting a more severe disease profile in males.

Features of the onset of Takayasu's arteritis according to gender.

BACKGROUND: Although there are various published epidemiological studies regarding Takayasu's arteritis (TA), none have analyzed the influence of gender on the clinical and laboratory manifestations or vascular alterations at disease onset. OBJECTIVES: To analyze the influence of gender on clinical and laboratory manifestations and variations in vascular imaging at TA onset. METHODS: A retrospective, unicentric cohort study that evaluated 55 consecutive TA patients between 1982 and 2012. All available clinical data and laboratory test results related to the onset of the disease were analyzed. We included only patients aged 12-35 years at diagnosis to exclude age-related factors. RESULTS: We analyzed 17 men and 38 women, mostly Caucasian, with a comparable mean age between genders. There was no gender difference regarding the clinical or laboratory characteristics, comorbidities, or smoking habit, except for abdominal pain, which was more common in men. Regarding vascular lesions, the presence of ascending aortic aneurysms was significantly more frequent in males. Male gender represented an independent risk factor for the occurrence of abdominal pain and ascending aortic aneurysms in TA patients. CONCLUSION: Abdominal pain and ascending aortic aneurysms occurred more frequently in men with TA, suggesting a more severe disease profile in males.