POS0331-PARE RHEUMATOID ARTHRITIS LEADS TO SEXUAL DYSFUNCTION AND REDUCED SEXUAL WELL-BEING EVEN IN THE ERA OF TARGETED TREATMENTS – A LITERATURE REVIEW
Authors: C. Savel, A. Frazier-Mironer, S. Tropé, D. Vacher, L. Gossec
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Rheumatoid arthritis (RA) is more frequent in women (3:1) and affects all aspects of quality of life, including sexual health. The treatment landscape for RA has undergone a transformative shift with the approval of biological DMARDs, further expanded by JAK inhibitors, as well as a paradigm shift with the 'treat to target' approach. These elements have positively impacted patient quality of life however the potential improvement of sexual health remains to be determined. <h3>Objectives:</h3> To explore the frequency and determinants of sexual dysfunction in RA patients, with a focus on changes with the advent of targeted treatments (bDMARDs/JAK inhibitors), and the "treat-to-target" strategy, through a literature review. <h3>Methods:</h3> An expert group consisting of rheumatologists, a health professional specialized in sexual health and patients with RA was convened to define the key questions regarding sexual health in RA. Then a comprehensive literature review was conducted on MEDLINE, EMBASE, and the Cochrane Library in December 2023, exploring original articles, meta-analyses, and review papers using various combinations of keywords: "rheumatoid arthritis", "sexual health", "sexual dysfunction" and "DMARDs". All papers reporting sexual health/dysfunction frequency, determinants and links with treatments were analysed on full text. Subsequent focused searches were performed on individual bDMARDs and tsDMARD to assess their association with sexual dysfunction. Due to the high heterogeneity, the analyses were descriptive. <h3>Results:</h3> The literature search identified 19 studies, including 15 cross-sectional population analyses, 1 case-control study, 1 meta-analysis, 1 post-hoc analysis of phases 3 and 1 observational study (Table 1). No interventional study directly addressing the topic was identified. Overall, 30 to 76% of patients with RA presented with sexual dysfunction across the studies.1 We could not identify a trend over time for prevalence. RA could impact sexual activity through joint pain, fatigue, dyspareunia, psychological effects, medication side effects, and body image changes. One questionnaire was specifically created for patients with RA (Qualisex). No clear link was identified between sexual dysfunction and treatments received; cross-sectional studies did not generally identify an association though some studies suggested a modest improvement in sexual function in men with biologic drugs, particularly concerning erectile dysfunction. One post-hoc analysis of phases 3 FINCH 1, FINCH 2 and FINCH 3 reported that active treatment with filgotinib (FIL) or adalimumab (ADA) resulted in early and sustained improvements from baseline in sexual function.2 One observational study reported a link between a JAKi (tofacitinib) and improved sexual health.3 The relationship between disease activity and sexual function remained unclear. Most authors reported that the sexual health of RA patients was overlooked by health practitioners. <b>Table 1.</b> RA and sexual dysfunction studies synthesis <h3>Conclusion:</h3> Sexual health was found to be very often altered in this literature review. The existing literature did not conclusively determine whether the introduction of targeted drugs and the "treat-to-target" strategy has improved sexual well-being of RA patients. Despite the frequent deterioration in the sexual health of patients with RA, rheumatologists most often did not spontaneously address this aspect during consultations, emphasizing the importance of communication and education tools for both patients and caregivers. Further research is needed to better understand and address, through holistic patient care, the sexual health of RA patients. <h3>REFERENCES:</h3> [1] Tristano AG. World J Orthop 2014;5:107-11 [2] Perez-Garcia LF et al. Ann Rheum Dis 2021;80(Suppl 1):496 [3] Karabalut Y et al. Rheumatol Int 2022;42(9):1531-1537 <h3>Acknowledgements:</h3> Writing support and update was funded by Galapagos B.V., Mechelen, Belgium. <h3>Disclosure of Interests:</h3> <b>None declared.</b>