Diagnostic accuracy of the aging males’ symptoms questionnaire for screening androgen deficiency in patients with psoriatic arthritis

Approximately 50% of patients with psoriatic arthritis (PsA) are men, and the frequency of testosterone deficiency in patients with PsA can reach 36%, therefore it’s relevant to study the methods for clinical detection of hypogonadism symptoms in patients of this cohort. Objective. To evaluate the sensitivity and specificity of Aging Males’ Symptoms (AMS) questionnaire for the diagnosis of hypogonadism in patients with psoriatic arthritis. Materials and methods. An one-time continuous study included 80 males with PsA, who were on hospital treatment in V.A. Nasonova Research Institute of Rheumatology. The patients were tested for total testosterone level. Hypogonadism was diagnosed when total testosterone level was ≤12.0 nmol/l. Correlation analysis between the questionnaire of scores on AMS and testosterone level and clinical laboratory parameters of PsA was carried out. ROC-analysis of sensitivity and specificity of AMS questionnaire compared with hypogonadism laboratory diagnosis in patients of this sample was performed. Results. Symptoms of androgen deficiency are suspected in 78.8% according to the questionnaire results. Hypogonadism (decrease in testosterone level below 12 nmol/l) has been found in 36.3% of patients. There was no statistically significant correlation between testosterone level and total number of AMS scores, as well as between evaluation in the scores of the separate components of AMS questionnaire. Significant positive correlations (mainly on total scores number, evaluation of somatic and sexual issues) with age, length of PsA, BASDAI activity index have been found, but not with DAPSA. Negative correlations between evaluation of separate AMS questionnaire components, hemoglobin level and glomerular filtration rate have been observed. In the ROC-analysis, the area under the ROC-curve was 0.513 (95% CI 0.382—0.644; p=0.85). The sensitivity of questionnaire was 78.4%, specificity — 24.1% at the point of 27 scores. The diagnostic accuracy of questionnaire was 38.8%, predictive value of positive result — 33.3%, predictive value of negative result — 58.8%. Conclusion. The AMS questionnaire showed a low diagnostic accuracy for androgen deficiency in men with psoriatic arthritis, which may be due to a significant contribution of disease activity and caused by this process functional disorders to the questionnaire results. Routine laboratory assessment of testosterone level in men with psoriatic arthritis is appropriate with consideration to the high frequency of hypogonadism in this pathology.