J. Rech¹, J. Zwerina¹, J. Distler¹, N. Blank², O. Distler³, G. Schett^1
1Medical Department III, University of Erlangen-Nuremberg, Erlangen, ²Internal Medicine V, Division of Rheumatology, Uniersity of Heidelberg, Heidelberg, Germany, ³Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland

Objectives: Studies have shown that erectile dysfunction (ED) occurs frequently in SSc and is more common than in RA. The pathophysiological mechanism of ED is not clearly defined but it has been shown that ED in patients with chronic illness is an organic not a psychogenic problem. The occurance in other rheumatologic diseases and the timing of ED in the disease course have not been studied so far.
Methods: We report on 7 patients with rheumatic diseases (SSc, CREST Syndrom, UCTD, Raynaud's Phenomenon) who were mailed three confidential questionnaires (KEED = Koelner Erfassungsbogen für ED, Erectile function domain and DSM-IV). After given informed consent the demographic data (age, medical history, medication and rheumatic disease status) was documented by the physicians while the results of the questionnaires was collected and documented in our center (University of Erlangen-Nuremberg, Director: G. Schett).
Results: The median age of the patients was 47 years with a range from 33 years to 65 years. The response rate for the questionnaire was 71% (5/7). All patients reported that erectile function was limited and three out of four patients reported that they are mostly unable to have sex with their partners. In one patient we have seen that ED and Raynaud's phenomenon occurs four years before the diagnosis of the CREST syndrome was made.

Conclusion: Although the number of patients is still very limited, these preliminary results indicate that ED is not only a problem in SSc patients. It may also occur in other patients with rheumatologic diseases where vascular lesions or vascular phenomena like Raynaud's phenomenon play an important role. While ED is an important clinical symptom physicians of all disciplines should be aware about it. However, in patients where ED occurs first and more “typical” explanations like hypertension, diabetes and others were excluded, physicians should think about the possibility of an underlying autoimmune disease. This study is ongoing and will be updated.
References: 1.) Hong P, Pope JE, Ouimet JM, Rullan E, Seibold JR; Erectile dysfunction associated with scleroderma: a case-control study of men with scleroderma and rheumatoid arthritis. J Rheumatol. 2004 Mar;31(3):508-13; Comment in J Rheumatol. 2004 Oct;31(10):2091; author reply 2091-2.
2.) M. Braun, T. Klotz, B. Reifenrath, M. Mathers, G. Wassmer, A. Schoenenberger, U. Engelmann; Die Prävalenz von männlichen Erektionsstörungen in Deutschland heute und in der Zukunft. The prevalence of male erectile dysfunction in Germany today and in the future. Aktuel Urol 2000; 31: 302-307 DOI: 10.1055/s-2000-7200.
3.) Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A.; The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997 Jun;49(6):822-30.
4.) American Psychiatric Association (1994) DSM-IV: Diagnostic and Statistical manual of mental disorders, 4th edn. American Psychiatric Press, Washington DC