Skip to main content
Top

11-04-2018 | Rheumatoid arthritis | Article

Sexual health in patients with rheumatoid arthritis and the association between physical fitness and sexual function: a cross-sectional study

Journal: Rheumatology International

Authors: Thomas Ernst Dorner, Carolin Berner, Sandra Haider, Igor Grabovac, Thomas Lamprecht, Karl Heinrich Fenzl, Ludwig Erlacher

Publisher: Springer Berlin Heidelberg

Abstract

The aim of this study was to examine sexual health in patients with rheumatoid arthritis (RA), and to analyse factors associated with sexual health with a focus on physical fitness. One hundred RA patients aged between 18 and 65 years were included in a cross-sectional study. Handgrip strength and knee extensor strength were measured with a dynamometer, and physical performance with the Short Physical Performance Battery (SPPB). Fifty-four patients, mean age 47.8 (SD 10.6) years, 61% female, answered a questionnaire about sexual health. Fifty-seven percent reported, at least, sometimes having difficulty with sexual intercourse (27.8% due to joint stiffness, 24.1% due to fatigue, 18.5% due to pain). Handgrip strength and knee extensor strength significantly correlated with the desire to engage in sexual intercourse, frequency of sexual contact and satisfaction with overall sex life. The SPPB total score correlated with satisfaction with overall sex life, and the SPPB repeated chair stands test with the desire to have sexual intercourse and satisfaction with overall sex life. After adjusting for age, gender, disease activity, comorbidity, co-medication and pain intensity, the repeated chair stands test remained significantly associated with the frequency of sexual contact (0.53; 0.01–1.05) and with satisfaction with overall sex life (1.39; 0.28–2.51). The results of this study show that problems with sexual health are highly prevalent in patients with RA. The ability to rise from a chair is associated with sexual function, independent of disease activity and pain intensity.
Literature
1.
Kvien TK, Uhlig T (2005) Quality of life in rheumatoid arthritis. Scand J Rheumatol 34(5):333–341. https://​doi.​org/​10.​1080/​0300974050032772​7 CrossRefPubMed
2.
Dorner TE, Stronegger WJ, Rebhandl E, Rieder A, Freidl W (2010) The relationship between various psychosocial factors and physical symptoms reported during primary-care health examinations. Wiener Klinische Wochenschrift 122(3–4):103–109. https://​doi.​org/​10.​1007/​s00508-010-1312-6 CrossRefPubMed
3.
Pieber K, Stein KV, Herceg M, Rieder A, Fialka-Moser V, Dorner TE (2012) Determinants of satisfaction with individual health in male and female patients with chronic low back pain. J Rehabil Med 44(8):658–663. https://​doi.​org/​10.​2340/​16501977-1010 CrossRefPubMed
4.
Tristano AG (2014) Impact of rheumatoid arthritis on sexual function. World J Orthop 5(2):107–111. https://​doi.​org/​10.​5312/​wjo.​v5.​i2.​107 CrossRefPubMedPubMedCentral
5.
Khnaba D, Rostom S, Lahlou R, Bahiri R, Abouqal R, Hajjaj-Hassouni N (2016) Sexual dysfunction and its determinants in Moroccan women with rheumatoid arthritis. Pan Afr Med J 24:16. https://​doi.​org/​10.​11604/​pamj.​2016.​24.​16.​9081 CrossRefPubMedPubMedCentral
6.
Saadat SH, Ramezani A, Ahmadi K (2015) Sexual self-concept and general health in rheumatoid arthritis patients. Iran Red Crescent Med J 17(10):e19005. https://​doi.​org/​10.​5812/​ircmj.​19005 CrossRefPubMedPubMedCentral
7.
Hari A, Rostom S, Lahlou R, Bahiri R, Hajjaj-Hassouni N (2015) Sexual function in Moroccan women with rheumatoid arthritis and its relationship with disease activity. Clin Rheumatol 34(6):1047–1051. https://​doi.​org/​10.​1007/​s10067-015-2888-z CrossRefPubMed
8.
Kobelt G, Texier-Richard B, Mimoun S, Woronoff AS, Bertholon DR, Perdriger A, Maugars Y, Combe B (2012) Rheumatoid arthritis and sexuality: a patient survey in France. BMC Musculoskelet Disord 13:170. https://​doi.​org/​10.​1186/​1471-2474-13-170 CrossRefPubMedPubMedCentral
9.
van Berlo WT, van de Wiel HB, Taal E, Rasker JJ, Weijmar Schultz WC, van Rijswijk MH (2007) Sexual functioning of people with rheumatoid arthritis: a multicenter study. Clin Rheumatol 26(1):30–38. https://​doi.​org/​10.​1007/​s10067-006-0216-3 CrossRefPubMed
10.
El Miedany Y, El Gaafary M, El Aroussy N, Youssef S, Ahmed I (2012) Sexual dysfunction in rheumatoid arthritis patients: arthritis and beyond. Clin Rheumatol 31(4):601–606. https://​doi.​org/​10.​1007/​s10067-011-1891-2 CrossRefPubMed
11.
Josefsson KA, Gard G (2012) Sexual health in patients with rheumatoid arthritis: experiences, needs and communication with health care professionals. Musculoskelet Care 10(2):76–89. https://​doi.​org/​10.​1002/​msc.​1002 CrossRef
12.
Yilmaz H, Polat HA, Yilmaz SD, Erkin G, Kucuksen S, Salli A, Ugurlu H (2012) Evaluation of sexual dysfunction in women with rheumatoid arthritis: a controlled study. J Sex Med 9(10):2664–2670. https://​doi.​org/​10.​1111/​j.​1743-6109.​2012.​02882.​x CrossRefPubMed
13.
Clayton AH, Harsh V (2016) Sexual function across aging. Curr Psychiatry Rep 18(3):28. https://​doi.​org/​10.​1007/​s11920-016-0661-x CrossRefPubMed
14.
Baker JF, Von Feldt J, Mostoufi-Moab S, Noaiseh G, Taratuta E, Kim W, Leonard MB (2014) Deficits in muscle mass, muscle density, and modified associations with fat in rheumatoid arthritis. Arthritis Care Res (Hoboken) 66(11):1612–1618. https://​doi.​org/​10.​1002/​acr.​22328 CrossRef
15.
Giles JT, Bartlett SJ, Andersen RE, Fontaine KR, Bathon JM (2008) Association of body composition with disability in rheumatoid arthritis: impact of appendicular fat and lean tissue mass. Arthritis Rheum 59(10):1407–1415. https://​doi.​org/​10.​1002/​art.​24109 CrossRefPubMedPubMedCentral
16.
Stucki G, Bruhlmann P, Stucki S, Michel BA (1998) Isometric muscle strength is an indicator of self-reported physical functional disability in patients with rheumatoid arthritis. Br J Rheumatol 37(6):643–648CrossRefPubMed
17.
Frappier J, Toupin I, Levy JJ, Aubertin-Leheudre M, Karelis AD (2013) Energy expenditure during sexual activity in young healthy couples. PLoS One 8(10):e79342. https://​doi.​org/​10.​1371/​journal.​pone.​0079342 CrossRefPubMedPubMedCentral
18.
de Menezes Franco M, Driusso P, Bo K, Carvalho de Abreu DC, da Silva Lara LA, de Sa Rosa ESACJ., Ferreira CHJ (2017) Relationship between pelvic floor muscle strength and sexual dysfunction in postmenopausal women: a cross-sectional study. Int Urogynecol J 28(6):931–936. https://​doi.​org/​10.​1007/​s00192-016-3211-5 CrossRefPubMed
19.
Lowenstein L, Gruenwald I, Gartman I, Vardi Y (2010) Can stronger pelvic muscle floor improve sexual function? Int Urogynecol J 21(5):553–556. https://​doi.​org/​10.​1007/​s00192-009-1077-5 CrossRefPubMed
20.
Tsujimura A (2013) The relationship between testosterone deficiency and men’s health. World J Mens Health 31(2):126–135. https://​doi.​org/​10.​5534/​wjmh.​2013.​31.​2.​126 CrossRefPubMedPubMedCentral
21.
Berner C, Erlacher L, Quittan M, Fenzl KH, Dorner TE (2017) Workability and muscle strength in patients with seropositive rheumatoid arthritis: survey study protocol. JMIR Res Protoc 6(3):e36CrossRefPubMedPubMedCentral
22.
Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JMW, Hobbs K, Huizinga TWJ, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Menard HA, Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovsky J, Wolfe F, Hawker G (2010) 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 69(9):1580–1588CrossRefPubMed
23.
Roberts HC, Denison HJ, Martin HJ, Patel HP, Syddall H, Cooper C, Sayer AA (2011) A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing 40(4):423–429. https://​doi.​org/​10.​1093/​ageing/​afr051 CrossRefPubMed
24.
Maughan RJ, Watson JS, Weir J (1983) Strength and cross-sectional area of human skeletal muscle. J Physiol 338:37–49CrossRefPubMedPubMedCentral
25.
Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49(2):M85-94CrossRefPubMed
26.
Hawker GA, Mian S, Kendzerska T, French M (2011) Measures of adult pain: visual analog scale for pain (VAS Pain), numeric rating scale for pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res (Hoboken) 63(Suppl 11):S240-252
27.
Aletaha D, Nell VPK, Stamm T, Uffmann M, Pflugbeil S, Machold K, Smolen JS (2005) Acute phase reactants add little to composite disease activity indices for rheumatoid arthritis: validation of a clinical activity score. Arthritis Res Ther 7(4):R796–806CrossRefPubMed
28.
Stamm TA, Pieber K, Crevenna R, Dorner TE (2016) Impairment in the activities of daily living in older adults with and without osteoporosis, osteoarthritis and chronic back pain: a secondary analysis of population-based health survey data. BMC Musculoskelet Disord 17:139. https://​doi.​org/​10.​1186/​s12891-016-0994-y CrossRefPubMedPubMedCentral
29.
Morsley K, Berntzen B, Erwood L, Bellerby T, Williamson L (2017) Progressive resistance training (PRT) improves rheumatoid arthritis outcomes: a district general hospital (DGH) model. Musculoskelet Care. https://​doi.​org/​10.​1002/​msc.​1193 CrossRef
30.
Palamar D, Er G, Terlemez R, Ustun I, Can G, Saridogan M (2017) Disease activity, handgrip strengths, and hand dexterity in patients with rheumatoid arthritis. Clin Rheumatol. https://​doi.​org/​10.​1007/​s10067-017-3756-9 CrossRefPubMed
31.
Walsmith J, Abad L, Kehayias J, Roubenoff R (2004) Tumor necrosis factor-alpha production is associated with less body cell mass in women with rheumatoid arthritis. J Rheumatol 31(1):23–29 pii]PubMed
32.
Visser M, Pahor M, Taaffe DR, Goodpaster BH, Simonsick EM, Newman AB, Nevitt M, Harris TB (2002) Relationship of interleukin-6 and tumor necrosis factor-alpha with muscle mass and muscle strength in elderly men and women: the Health ABC Study. J Gerontol A Biol Sci Med Sci 57(5):M326–332CrossRef
33.
Bouloukaki I, Papadimitriou V, Sofras F, Mermigkis C, Moniaki V, Siafakas NM, Schiza SE (2014) Abnormal cytokine profile in patients with obstructive sleep apnea-hypopnea syndrome and erectile dysfunction. Mediat Inflamm 2014:568951. https://​doi.​org/​10.​1155/​2014/​568951
34.
Agarwal A, Gupta S, Sharma RK (2005) Role of oxidative stress in female reproduction. Reprod Biol Endocrinol 3:28CrossRefPubMedPubMedCentral
35.
Burney BO, Hayes TG, Smiechowska J, Cardwell G, Papusha V, Bhargava P, Konda B, Auchus RJ, Garcia JM (2012) Low testosterone levels and increased inflammatory markers in patients with cancer and relationship with cachexia. J Clin Endocrinol Metab 97(5):E700-709. https://​doi.​org/​10.​1210/​jc.​2011-2387 CrossRef
36.
Finkelstein JS, Yu EW, Burnett-Bowie SA (2013) Gonadal steroids and body composition, strength, and sexual function in men. N Engl J Med 369(25):2457. https://​doi.​org/​10.​1056/​NEJMc1313169 CrossRefPubMed
37.
Lemmey AB, Marcora SM, Chester K, Wilson S, Casanova F, Maddison PJ (2009) Effects of high-intensity resistance training in patients with rheumatoid arthritis: a randomized controlled trial. Arthritis Rheum 61(12):1726–1734. https://​doi.​org/​10.​1002/​art.​24891 CrossRefPubMed
38.
Haider S, Grabovac I, Winzer E, Kapan A, Schindler KE, Lackinger C, Titze S, Dorner TE (2017) Change in inflammatory parameters in prefrail and frail persons obtaining physical training and nutritional support provided by lay volunteers: a randomized controlled trial. PLoS One 12(10):e0185879. https://​doi.​org/​10.​1371/​journal.​pone.​0185879 CrossRefPubMedPubMedCentral
39.
Colbert LH, Visser M, Simonsick EM, Tracy RP, Newman AB, Kritchevsky SB, Pahor M, Taaffe DR, Brach J, Rubin S, Harris TB (2004) Physical activity, exercise, and inflammatory markers in older adults: findings from the health, aging and body composition study. J Am Geriatr Soc 52(7):1098–1104. https://​doi.​org/​10.​1111/​j.​1532-5415.​2004.​52307.​x CrossRefPubMed
40.
Atallah S, Johnson-Agbakwu C, Rosenbaum T, Abdo C, Byers ES, Graham C, Nobre P, Wylie K, Brotto L (2016) Ethical and sociocultural aspects of sexual function and dysfunction in both sexes. J Sex Med 13(4):591–606. https://​doi.​org/​10.​1016/​j.​jsxm.​2016.​01.​021 CrossRefPubMed