Original article Erectile dysfunction of sclerodermic patients correlates with digital vascular damage Edoardo Rosato a , Antonio Aversa b , Ilenia Molinaro a , Simonetta Pisarri a , Giovanni Spera b , Felice Salsano a, ⁎ a Sapienza University of Rome, Department of Clinical Medicine, Clinical Immunology Unit, Scleroderma Center, Italy b Sapienza University of Rome, Cattedra di Medicina Interna, Dipartimento Fisiopatologia Medica, Italy abstract article info Article history: Received 13 May 2010 Received in revised form 29 July 2010 Accepted 24 September 2010 Available online 16 October 2010 Keywords: Systemic sclerosis Erectile dysfunction Raynaud's phenomenon of penis Capillaroscopy Background: The prevalence of erectile dysfunction (ED) in men with systemic sclerosis (SSc) can be considered a manifestation of endothelium damage. Aim of the study is to investigate ED in SSc patients by color Doppler ultrasound examination and to correlate it with disease severity and digital vascular damage. Methods: In 20 males SSc patients blood flow velocity in the cavernous artery was determined with Duplex ultrasonography. Naifold videocapillaroscopy, Sexual Health Inventory for Men (SHIM) and Medsger Disease Severity Scale (DSS) were performed. Arteriogenic ED was defined by the presence of a reduced peak systolic velocity (PSVs), while diastolic velocity (EDV) and the resistive index (RI) were estimated to evaluate venocclusive dysfunction. SSc patients are classified by capillaroscopic pattern and vascular domain of DSS into two groups: low vascular damage (early or active capillaroscopic pattern and score of vascular domain of DSS ≤ 2) and high vascular damage (late capillaroscopic pattern and score of vascular domain of DSS ≥ 3). Results: In all SSc patients a reduction of SHIM is present (mean 13.5 ± 6.3). Patients with less vascular damage have a significantly (p b 0.001) higher score of SHIM than patients with greater vascular damage (19.2 ± 2.4 vs 7.9 ± 2.7). No significant difference (p N 0.5) between the two groups of vascular damage was found in PSVs. Venocclusive dysfunction was present only (p b 0.001) in the group with high vascular damage. Conclusion: We can assert that there is a relationship between SSc vascular digital damage and ED. © 2010 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. 1. Introduction Systemic sclerosis (SSc) is an autoimmune disease with vascular alterations and endothelial damage, leading to progressive, wide- spread fibrosis of various organs. Irrespective of the classification of the disease, SSc is typically associated with Raynaud's phenomenon (RP). RP secondary to SSc is characterized by microvascular damage, high plasma adrenomedullin and endothelin-l (ET-1) levels, reduced production of Nitric Oxide (NO). Early disease is mediated through microvascular dysfunction secondary to a number of factors including endothelial damage, over-expression of specific adhesion molecules and perivascular inflammatory cell infiltration. Endothelial cell injury might be triggered by vasculotropic viruses, inflammatory cytokines, granzymes, endothelial cell-specific autoantibodies or elevated levels of reactive oxygen species due to oxidative stress [1,2]. The association between SSc and impotence was first described in 1981 by Lally and Jimenez [3]. The prevalence of erectile dysfunction (ED) in men with SSc may be as high as 81%, and it can be considered a manifestation of endothelium damage [4,5]. Aim of this study was to investigate ED in SSc patients by color Doppler ultrasound examination and correlate it with disease severity and digital vascular damage. 2. Materials and methods We enrolled 20 males patients (mean age 49 ± 25 years) who fulfilled the American College of Rheumatology (formerly, the American Rheumatology Association) preliminary criteria for the classification of SSc [6]. All SSc patients were subsequently divided into limited (lcSSc) and diffuse (dcSSc) cutaneous SSc groups according to LeRoy [7]. Table 1 lists epidemiological and clinical features of the study population. The subjects' written consent was obtained according to the Declaration of Helsinki and the study was approved by local ethics committee. Patients entering in the study continue treatment with calcium channel blockers (nifedipine 30 mg/die) and with parenteral prosta- noids for treatment of Raynaud's phenomenon and digital ulcers. Therapy with nifedipine was discontinued 48 h before the ultrasono- graphic examination. Echo Color Doppler examination was performed at least 30 days from the last intravenous infusion of prostacyclin analogues and/or nitrates or nitric oxide-donor drugs. Pulmonary arterial hypertension, concomitant treatment with ET- 1 receptor antagonists and androgens, arterial hypertension, hypo- gonadis hyperlipidaemia, cardiac failure, hepatic failure, diabetes European Journal of Internal Medicine 22 (2011) 318–321 ⁎ Corresponding author. Sapienza University of Rome, Department of Clinical Medicine, Viale dell'Università 37, 00185 Rome, Italy. Tel.: + 39 06 49972040; fax: + 39 0649972071. E-mail address: felice.salsano@uniroma1.it (F. Salsano). 0953-6205/$ – see front matter © 2010 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.ejim.2010.09.013 Contents lists available at ScienceDirect European Journal of Internal Medicine journal homepage: www.elsevier.com/locate/ejim