Gout, the most common type of inflammatory arthritis, has been associated with a variety of comorbidities, including erectile dysfunction. Although limited data exist on the relationship between erectile dysfunction and gout, results from a recent population-based cohort study determined that there is a significant increased risk for impotence among men with the disease (Abdul Sultan A, et al. Arthritis Res Ther. 2017;19:123).
Because of the lack of studies quantifying the risk for erectile dysfunction among men with gout, Alyshah Abdul Sultan, PhD, Research Fellow, Epidemiology/Applied Statistics, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, United Kingdom, and colleagues sought to define the absolute and relative rates of erectile dysfunction among men with gout in England during a 10-year time frame.
“In this large nationally representative cohort of men with gout with more than 10 years of follow-up, we have provided contemporary, generalisable and population-based estimates of the absolute risk of ED reporting in England....These findings are not only generalisable to England but also to other developed nations with comparable health care systems,” the researchers wrote.
Dr. Abdul Sultan and colleagues identified 9653 patients with gout using the Clinical Practice Research Datalink—a large, long-term database comprising anonymous primary care records—and matched them for age and sex with 38,218 healthy controls. Patients with gout and healthy controls represented 90,036 and 302,814 person-years of follow-up, respectively.
Reports of erectile dysfunction were determined through medical codes assigned by the physician, and pharmacologic treatment for erectile dysfunction was defined as patients who were prescribed pharmacologic treatment for their impotence at any point after their initial diagnosis. The investigators used Cox regression models to calculate the absolute and relative rates of incident erectile dysfunction, and compared absolute rates for specific timeframes between patients and healthy controls with a Poisson regression model.
Overall, 5860 instances of erectile dysfunction were reported during the study; patients with gout had an absolute rate of 193 per every 10,000 person-years for erectile dysfunction (95% confidence interval [CI], 184-202), which corresponded to a relative risk increase of 31% (hazard ratio, 1.31; 95% CI, 1.24-1.40) and excess absolute risk of 0.6% compared with those without gout.
When results were stratified by patient characteristic, results were consistent, and Dr. Abdul Sultan and colleagues did not note any significant differences in risk for impotence among patients with gout who were prescribed a urate-lowering therapy within 1 to 3 years of diagnosis.
Among men with gout, absolute rates of erectile dysfunction that received pharmacologic treatment were 107 per every 10,000 person-years (95% CI, 107-121), with an excess absolute risk of 0.3% compared with controls.
Of note, those with gout were 1.77 times more likely to have a higher relative risk for reporting erectile dysfunction during their second year of diagnosis compared with controls.
“The increased relative risk is broadly similar when stratified by comorbidities suggesting limited interaction with those factors. These findings may have important implications in planning a multidisciplinary approach to managing patients with gout,” Dr Abdul Sultan and colleagues said.
They also elaborated on their observation of an increased relative risk for erectile dysfunction in the year leading up to a diagnosis of gout, and discussed the potential role of hyperuricemia in men who have erectile dysfunction but have not been diagnosed with gout.
“Our findings support the likely physiological influence of hyperuricaemia on vasculature including induction of vascular smooth muscle proliferation, oxidative stress, and activation of the renin-angiotensin axis in vascular beds which begins in asymptomatic hyperuricaemia before the clinical diagnosis of gout...It may be more reasonable to suspect hyperuricaemia as one of the underlying causes of ED [erectile dysfunction] among men with asymptomatic hyperuricaemia but are yet to develop clinically apparent gout,” Dr Abdul Sultan and colleagues concluded.