What does affect the sexual behaviour in fibromyalgic patients? 2011 Annual Scientific Meeting in Arthritis & Rheumatism

Background/Purpose: Sexuality is an important aspect of life. The prevalence of sexual difficulties in patients with chronic pain is high (Ambler et al., 2001). The aim of our study was to compare the sexual behavior of patients with fibromyalgia (FM) with patients affected by rheumatoid arthritis (RA). FM is a chronic disease characterized by widespread pain and symptoms associated with several neurovegetative disorders. RA is a chronic, systemic and inflammatory condition characterized by pain, disability and joint deformations. Both FM and RA affect all domains of life, with a severe impairment in terms of quality, involving also the sexual behavior. Methods: We enrolled 100 patients with FM, 20 patients with RA and 25 healthy subjects (all females of comparable age). All subjects were administered the questionnaires “Index of Sexual Satisfaction” (ISS) and “Female Sexual Function Index” (FSFI). The ISS assesses, using 25 items, sexual functioning as a natural part of a relationship; the patients with an overall score higher than 30 points (cut-off point) were considered to have sexual dysfunction. The FSFI assesses sexual satisfaction and includes the domain of sexual desire, arousal, lubrication, orgasm, satisfaction, and pain during sexual intercourse. The maximum score for total FSFI is 36, a good sexual function is associated with higher scores, the total score of less than 22.7 is indicative of sexual dysfunction. Results: The mean age of FM patients was 47 years ( 8), the mean number of TP was 16.95 ( 2.80), VAS pain 6.3 ( 2.6) and FIQ total score 59.7 ( 18.7). The mean age of RA patients was 48.6 years ( 9), the mean HAQ values was 0.65 045, DAS28 was 3.80 1.91 and VAS 5 2.7. The mean age of the healthy controls was 40.5 ( 10). The percentage of postmenopausal patients was 41% in FM and in RA and 23% in healthy controls. The mean ISS score is significantly greater in FM patients (34.25 9.58) than that for healthy controls (24.39 14.00), and did not differ between FM and RA (28.87 16.70) and between RA and controls. Fifty-seven % of patients with FM had ISS 30, indicative of sexual dysfunction versus 36% of healthy controls (p0.005). No differences were found between ISS values of healthy controls vs RA patients (42%) and between RA vs FM patients. The mean total FSFI score did not differ between the 3 groups of subjects (FM21.338.04, RA22.526.66, controls23.844.84). When the subscores of each domain were evaluated, the most common sexual problem was diminished arousal, lubrication, satisfaction in FM patients and diminished pain during intercourse and orgasm in RA patients. The percentage of patients with FSFI22.7, indicative of sexual dysfunction, is significantly greater in FM and RA patients compared with controls (48%, 39%, 10.5%, p 0.0001). Conclusion: The sexual behavior of both FM and RA patients is affected by rheumatic disease, but probably in different ways; the couple’s relationship of FM patients (as indicated by greater ISS values) appears to have considerable weight with respect to sexual dysfunction, suggesting that in FM patients emotions may play a crucial role in sexual behavior, perhaps deeper than that played by pain and physical disability