Frequency of hypogonadism and clinical features of systemic sclerosis and idiopathic inflammatory myopathies in men depending on testosterone levels

Background. It is assumed that chronic immune-inflammatory rheumatic disease may be a factor increasing the likelihood of developing hypogonadism syndrome, and vice versa – the presence of uncompensated testosterone deficiency may predispose to a higher risk of developing or a more severe course of immune-inflammatory rheumatic disease.

Aim. To study the frequency of hypogonadism in men with systemic sclerosis (SSc) and idiopathic inflammatory myopathy (IIM) and its associations with clinical manifestations of SSc and IIM.

Materials and methods. A total of 65 patients were included in the one-stage continuous study, including 39 with SSc and 26 with IIM, who were undergoing inpatient treatment at Nasonova Research Institute of Rheumatology. The patients underwent determination of the level of total testosterone with subsequent division into subgroups with normal (>12 nmol/l) and reduced levels. An intergroup comparison was performed using the main indicators used in clinical rheumatology practice to assess the clinical and demographic characteristics of SSc and IIM. A correlation analysis was performed between the level of total testosterone and some clinical and laboratory indicators.

Results. The frequency of detected testosterone deficiency in SSc was 23.1%, and in IIM – also 23.1%. Patients with hypogonadism and SSc, compared with the group with normal testosterone levels, were characterized by a higher body mass index – BMI (27.0 [25.8; 29.8] kg/m² vs 23.5 [22.0; 26.1] kg/m²; p=0.033), were more often obese (77.8% vs 33.3%; p=0.022) and had a higher mean fasting glucose level (5.62 [5.27; 5.69] mmol/l vs 5.03 [4.82; 5.33] mmol/l; p=0.037). In addition, patients with hypogonadism were more often positive for anti-Scl70 (100.0% vs 40.7%; p=0.003) and had a trend towards higher titers of antinuclear factor (p=0.063). Significant inverse correlations were found between total testosterone levels and BMI, as well as antinuclear factor titer. Patients with IIМ and hypogonadism were characterized by a higher frequency of interstitial lung disease (66.7% vs 15.0%; p=0.012). Significant negative correlations were found between total testosterone levels and age, BMI and erythrocyte sedimentation rate.

Conclusion. A high frequency of hypogonadism was shown in men with SSc and IIМ. Reduced testosterone levels were accompanied by some metabolic disorders, as well as a high frequency of antibodies and clinical features characteristic of a more unfavorable course of the disease.