Daniel Zavadaa, Barbora Heřmánkováa, V. Losterovaa, L. Moravcováa, J. Vencovskýa b, L. Šenolta b, K. Pavelkaa b, Martin Tomčíka b
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Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease that significantly impacts quality of life in multiple domains. To the best of our knowledge, no studies have evaluated the impact of initial biological therapy on sexual function, despite its critical role in overall quality of life. Objectives: This prospective monocentric study aimed to evaluate the impact of initial biologic or targeted synthetic disease modifying anti-rheumatic drug (b/tsDMARD) therapy on sexual function in women with RA enrolled in the Czech ATTRA registry. Specifically, the study sought to assess changes in sexual function over six months of treatment and identify clinical and laboratory predictors of these changes. Methods: Women diagnosed with RA, indicated for b/tsDMARD therapy within the Czech ATTRA registry were recruited for this prospective study. Participants provided informed consent and completed the Female Sexual Function Index (FSFI) at baseline (M0) and after six months (M6). Routine clinical and laboratory data was collected, as well as patient-reported outcomes regarding function and quality of life (Health Assessment Questionnaire (HAQ), 36-Item Short Form Health Survey (SF-36), EuroQoL 5-Dimension Questionnaire (EuroQoL), Multidimensional Health Assessment Questionnaire (MDHAQ)). Results: A total of 36 women completed the questionnaires at both time intervals (mean ± SD at M0: age 45.3 ± 9.9 years; DAS28-ESR 5.43 ± 1.04; DAS28-CRP 5.31 ± 1.07; 74.3% were RF positive, and 76.5% were anti-CCP positive), and were treated with b/tsDMARD therapy: 94.4% with anti-TNF agents (adalimumab: 52.8%, certolizumab: 13.9%, etanercept: 25.0%, golimumab: 2.8%) and 5.6% with JAK inhibitors (baricitinib). At 6 months, 5/36 (13.9%) had switched therapies, with transitions to IL-6 inhibitors (tocilizumab, sarilumab), JAK inhibitors (baricitinib, tofacitinib), and alternative anti-TNF agents (golimumab). At the group level, 6 months of initial b/tsDMARD therapy had a significant positive effect on markers of inflammation (ESR, CRP), disease activity (tender joint count, swollen joint count, disease activity according to patient and physician [VASpt and VASph], DAS28ESR, and DAS28CRP), and function and quality of life (HAQ, MDHAQ, SF-36, and EuroQoL,). We observed only numerically slightly higher scores in individual domains and the total FSFI score, which did not reach statistical significance. However, the level of statistically significant improvement was barely missed in the FSFI domains desire (p=0.0965) and satisfaction (p=0.0691) (Table 1). At the individual level, 18 out of 32 participants (56.3%) demonstrated improvements in their total FSFI scores. Improvements in FSFI total and domain scores were significantly positively correlated with a decrease in CRP. Higher baseline CRP values also emerged as a significant predictor of larger improvement in FSFI total and domain scores. Unexpectedly, lower baseline tender/swollen joint count predicted a larger improvement in FSFI total or domain scores. In addition, worse baseline overall function (HAQ) predicted a larger improvement in FSFI desire (Table 2). Conclusion: This study highlights the potential role of CRP as both a predictor and correlate of improvement in sexual function during initial b/tsDMARD therapy in women with RA. While overall group-level changes in FSFI scores were not statistically significant, individual-level improvements were observed in over half of participants, with reductions in CRP strongly associated with improvement of sexual function (FSFI + domains). These findings underscore the importance of addressing systemic inflammation in improving quality of life, including sexual health, in RA treatment. Further research is warranted to confirm these associations and elucidate underlying mechanisms. REFERENCES: NIL . Acknowledgements: Supported by MHCR 023728. Disclosure of Interests: None declared . © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.
