SEXUAL HEALTH CHALLENGES IN PRIMARY ANTIPHOSPHOLIPID SYNDROME: EXPLORING PREVALENCE AND CLINICAL CORRELATES

PV188 / #82 Poster Topic: AS21 - Pregnancy and Reproductive Health Background/Purpose Antiphospholipid syndrome (APS) is a systemic thromboinflammatory disease with various forms of presentation. There is limited information on sexual function in patients with APS, and it is unclear whether it may be associated with chronic disease damage or if other clinical parameters can predict issues in this area of sexual health. Methods We conducted a cross-sectional study at 2 tertiary referral centers in Mexico City and Monterrey from January to May 2024. The study included patients aged ≥ 16 years who met the revised Sapporo criteria for APS and had been sexually active within the past 6 months. Patients with other autoimmune diseases, prothrombotic disorders, or chronic viral infections were excluded. All participants completed the Changes in Sexual Functioning Questionnaire-14 (CSFQ-14), which assesses various domains of sexuality, and had their ankle-brachial index (ABI) measured. Additionally, we asked 3 questions: 1) Do you think you have sexual dysfunction? 2) Would you be interested in being referred to a specialist if you have any alteration in your sexual function? and 3) Do you consider that your illness influences your sexual function? The damage index for patients with thrombotic antiphospholipid syndrome (DIAPS) was calculated, and additional demographic, clinical, and serological variables were recorded. Results We included 47 APS patients in the study. The mean age was 40.9 ± 10.9 years, with 87.5% being women, and the median disease duration was 7.0 years (IQR 7-14). Thrombotic APS was present in 68% of the patients. Most patients (70%) were taking vitamin K antagonists, and 30% were taking hydroxychloroquine. The 2 main comorbidities were obesity (25.5%) and dyslipidemia (23%). The average cumulative damage measured by DIAPS was 2, and the mean ABI was 0.97 ± 0.16. Sexual dysfunction was identified in 34% of patients based on their CSFQ-14 total score, with pleasure being the most affected domain (94%). Patients with sexual dysfunction had lower educational levels (12.8 vs. 15.8 years, p = 0.01), a higher history of immunosuppressant use (p = 0.03), greater history of thrombocytopenia (p = 0.04), and were more likely to believe they had sexual dysfunction (p = 0.01). However, they were less inclined to seek help from a sexual function specialist if needed (p = 0.003). When stratifying patients by gender, we found that more women experienced sexual dysfunction in the desire/frequency domain compared to men (70% vs. 30%, p = 0.05). Notably, a correlation was observed between total ABI and both the frequency domain (r = 0.31, p = 0.03) and the arousal/erection domain (r = 0.29, p = 0.04). Complementary variables are shown in Table 1 and Figure 1. Table 1. Baseline demographic, clinical and laboratory characteristics of patients with APS *Based on CSFQ-14 total score Figure 1. Patients with sexual dysfunction categorized by gender. Sexual dysfunction was assessed using the CSFQ-14 cut-off points for both the total score and the different domains. Conclusions This study is the first to outline the prevalence and clinical manifestations of sexual dysfunction in individuals with APS. Sexual function is impaired in these generally young patients who have few comorbidities and low chronic organ damage. Rheumatologists should consider this issue during regular visits and inquire about their patients’ sexual health. Further research is needed to determine the underlying pathophysiological mechanisms of this condition, but endothelial damage and thrombotic alterations may play a role. We are grateful to all the patients who kindly participated.

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