Features of the disease-modifying antirheumatic drugs for rheumatoid arthritis in men depending on testosterone levels

Abstract

Rheumatoid arthritis (RA) is associated with a high incidence of cardiovascular-kidney-metabolic conditions and hypogonadism syndrome in men. Objective. To study the features of antirheumatic therapy in men with rheumatoid arthritis and concomitant hypogonadism. Materials and methods. A total cross-sectional study including 169 men with a confirmed diagnosis of RA was carried out. Total testosterone level was measured in all patients; hypogonadism was diagnosed when the total testosterone level amounted to ≤12.0 nmol/L. A subgroup comparison of indicators reflecting the course and activity of RA, administered therapy and presence of concomitant diseases was performed in men with normal and reduced testosterone levels. Results. Patients with low testosterone level had similar RA duration, activity, and stage, but were less likely to receive methotrexate (26.8% versus 51.7%; p=0.006). Current duration of methotrexate administration or history of its intake was shorter in patients of the hypogonadism subgroup (1.0 [1.0; 3.0] year versus 3.0 [1.0; 7.0] years; p=0.027). In reduced testosterone level, a higher body mass index (31.0±4.0 kg/m2 and 26.1±3.7 kg/m2, respectively; p<0.001) and a higher incidence of obesity (63.7% compared to 10.6%; p<0.001) as well as diabetes mellitus (36.4% compared to 6.6%; p=0.004) were noted. The frequency and rate of application of other antirheumatic drugs were comparable, including the combination of methotrexate and genetically engineered biological therapy. Methotrexate withdrawal causes in the subgroups with normal and reduced testosterone levels did not differ statistically significantly. Nevertheless, a trend towards more frequent methotrexate discontinuation due to its poor tolerability was noted (26.8% compared to 14.1%; p=0.054) in patients of the group with reduced testosterone level. Conclusion. Hypogonadism in men with rheumatoid arthritis is associated with a higher incidence of comorbid metabolic disorders that contribute to methotrexate intolerance.