Clinical and instrumental characteristics of psoriatic arthritis in men depending on testosterone levels

The aim – to study the incidence of hypogonadism in men with psoriatic arthritis (PsA) and to assess its impact on PsA and comorbidities.

Materials and methods. A cross-sectional continuous study included 128 men with PsA who were hospitalized at the V.A. Nasonova Research Institute of Rheumatology. The patients underwent determination of their total testosterone levels and subsequent division into subgroups with normal (≥12.0 nmol/l) and reduced levels. An intergroup comparison was conducted for the main indicators used in clinical rheumatology practice to assess the stage, activity, and other medical and demographic characteristics of PsA, as well as for comorbidities. A correlation analysis was performed between the level of total testosterone and some clinical and laboratory parameters.

Results. The incidence of reduced total testosterone levels was 36.7%. Patients with testosterone deficiency were older (47.9±10.3 vs 40.1±12.1 years; p<0.001), had a higher body mass index (31.2±5.2 vs 27.2±6.1 kg/m2; p<0.001) and were more often obese (48.9% vs 23.4%; p=0.001). They had higher mean glucose levels (5.9±1.39 vs 5.34±0.57 mmol/l; p=0.001) and frequency of impaired fasting glycemia with similar frequency of type 2 diabetes mellitus. Patients with hypogonadism were characterized by higher uric acid levels (402.9±99.3 vs 354.0±81.5 μmol/L; p=0.003) and the frequency of hyperuricemia. A lower proportion of HLA-B27 positive patients was noted in the hypogonadism group, as well as a more frequent occurrence of stage III sacroiliitis (p=0.004) and a smaller amplitude of lateral flexion in the spine (10.3±3.3 vs 12.4±4.3 cm; p=0.014). Significant negative relationships were found between total testosterone levels and age, body mass index, glucose and uric acid levels, as well as a positive relationship with the amplitude of lateral flexion and chest excursion.

Conclusion. Hypogonadism was detected in one third of patients with PsA. Decreased testosterone levels were observed in older individuals and were associated with metabolic disorders, as well as with decreased spinal mobility and the presence of stage III of sacroiliitis.

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