Avaliação da função gonadal em pacientes do sexo masculino com dermatomiosite e polimiosite / Gonadal function evaluation in male patients with dermatomyositis and polymyositis

RESUMO

Objetivo: Avaliar a função gonadal de homens com miopatias inflamatórias idiopáticas (MII). Métodos: Vinte e cinco pacientes com MII foram avaliados e comparados com 25 homens saudáveis. Os pacientes foram subdivididos em dois sub-grupos de acordo com as alterações dos espermatozóides grupo A (n=10, duas ou mais das seguintes alterações terato/oligo/astenozoospermia ou azoospermia) e grupo B (n=15, teratozoospermia). Foram realizados exame urológico, ultra-sonografia testicular, análise dos espermatozóides (critérios da OMS e Kruger), pesquisa dos anticorpos anti-espermatozóides e dosagens hormonais Nos subgrupos foram também avaliados Disease Activity Score (DAS), Visual Analogue Scale (VAS), Manual Muscle Testing (MMT), myositis disease activity assessment visual analogue scales (MYOACT), myositis intention to treat activity index (MITAX), Myositis damage index [MDI], enzimas musculares e tratamento. Resultados: Pacientes apresentaram alterações nos espermatozóides comparados com controles com freqüência maior de nível elevado de FSH (20% versus 0%, p=0,05). O sub-grupo A apresentou freqüência e mediana maior do nível de CK (p=0,001 e p=0,001) assim como DAS (p=0,01), VAS (p=0,051), MMT (p=0,003). As medianas dos volumes testiculares foram menores no grupo A (direito, p=0,015 e esquerdo, p=0,025). As medianas dos parâmetros espermáticos foram reduzidas no grupo A [contagem total (p=0,0001); motilidade (p=0,0001); morfologia pela OMS (p=0,0001) e por Kruger (p=0,0001). A mediana de FSH foi elevada (p=0,035) e de androstenediona foi reduzida (p=0,02) no sub-grupo A. Afrequência de ciclofosfamida foi similar nos grupos (30% versus 6%, p=0,26). Conclusões: Atividade da doença foi o principal fator contribuinte para disfunção gonadal. Hipogonadismo hipergonadotrófico pode explicar as alterações anatômicas e funcionais observadas.

ABSTRACT

Objective: To perform a global gonad evaluation in male idiopathic inflammatory myopathies (IIM) patients. Methods: Twentyfive consecutive IIM were compared to 25 age-matched healthy subjects. Patients were subdivided in two groups according to the severity of sperm abnormalities group A (at least two of the following terato/oligo/asthenozoospermia or azoospermia) and group B (teratozoospermia). Patients and controls underwent a systematic assessment consisting of urologic examination, testicular ultrasound, semen analysis and hormones. Patients´ serum CK levels, visual analogue scale (VAS), disease activity score (DAS), manual muscle testing (MMT), myositis disease activity assessment visual analogue scales (MYOACT), myositis intention to treat activity index (MITAX), and Myositis damage index (MDI) were evaluated. Results: Several sperm variables were significantly altered compared to controls (p<0.05). The subgroup analysis according to the severity of sperm alterations revealed that the frequency of elevated CK and its median level was significantly higher in group A (p=0.001 and p=0.001), as also was DAS, VAS and MMT (p=0.01; p=0.051 and p=0.03). The median of testicular volumes were lower in group A (right p=0.015 and left p=0.025). All median sperm parameters were lower in group A (total sperm count, p=0.0001; total motile sperm count, p=0.0001; and sperm morphology by Kruger p=0.0001 and WHO p=0.0001). Higher median FSH (p=0.035) and lower median androstenedione levels (p=0.02) were observed in group A. The frequency of cyclophosphamide was similar in both groups (30% vs. 6%, p=0.26). Conclusions: Active disease was the major contributing factor for severe gonad dysfunction. The hypergonadotrophic hypogonadism may explain the anatomical and dysfunctional alterations observed.