The effect of anti-tumor necrosis factor agents on sexual dysfunction in male patients with ankylosing spondylitis: a pilot study.

Sexual dysfunction is a common problem among patients with ankylosing spondylitis (AS). This study was an open-label study without placebo to assess sexual dysfunction in male patients with AS, and to determine whether sexual function might improve with the use of tumor necrosis factor (TNF)-alpha blockers. Twenty-two males with AS (age, 29-48 years) were treated for 3 months with TNF-alpha blockers. Before and after treatment, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was measured, and all patients completed the International Index of Erectile Function (IIEF) questionnaire, a self-administered measure of sexual dysfunction with five domains: erectile function (EF), intercourse satisfaction (IS), orgasmic function (OF), sexual desire (SD) and overall satisfaction (OS). There were significant improvements in BASDAI after treatment with TNF-alpha blockers (P<0.001). Anti-TNF-alpha treated patients showed significant improvements in four out of the five IIEF domains (EF, P<0.001; IS, P<0.001; SD, P=0.006; OS, P=0.033). Among patients with erectile dysfunction, there were significant improvements in three IIEF domains (EF, P=0.006; IS, P=0.007; SD, P=0.018). Only IS domain of IIEF showed a significant correlation with BASDAI (partial correlation coefficient = -0.484, P=0.026). This study showed that anti-TNF-alpha therapy may improve sexual dysfunction in male AS patients, in addition to reducing disease activity.