From arthritis to erectile dysfunction: potential pathophysiological mechanisms and multidisciplinary integrated management

This review systematically examines the underlying mechanisms linking erectile dysfunction (ED) with arthritis and explores multidisciplinary management strategies. Epidemiological studies confirm that patients with various arthritis—including osteoarthritis (OA), rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), and gouty arthritis—exhibit significantly higher ED prevalence and incidence risks compared to the general population. This association remains independent of confounding factors such as age and comorbidities. Core mechanisms linking the two include chronic inflammation disrupting the “NO–cGMP–PKG” erectile molecular axis, vascular endothelial dysfunction causing insufficient penile blood supply, endocrine-metabolic disorders (e.g., insulin resistance, reduced testosterone), neuropsychological factors (anxiety, depression, chronic pain), and the synergistic effects of therapeutic agents (methotrexate, nonsteroidal anti-inflammatory drugs, glucocorticoids). Clinical recommendations advocate an “active screening-tiered assessment” approach, utilizing the International Index of Erectile Function (IIEF) combined with disease activity tools (e.g., DAS28, BASDAI) for screening and evaluation. Management should follow a multidisciplinary team (MDT) model integrating “control of underlying disease + individualized ED treatment + psychological intervention + lifestyle optimization” to improve patients’ overall health outcomes ultimately.