Use of the AMS questionnaire to hypogonadism screening in men with rheumatoid arthritis

Introduction. The proportion of men with rheumatoid arthritis (RA) reaches 25%. Given the previously identified high frequency of decreased testosterone in men with RA, the issue of clinical diagnosis of hypogonadism is relevant.

Aim. To evaluate the effectiveness of the Aging Male Symptoms (AMS) questionnaire for diagnosing hypogonadism among patients with RA.

Materials and methods. A cross-sectional continuous study included 78 men with RA who were undergoing inpatient treatment at the V.A. Nasonova Research Institute of Rheumatology. The patients underwent determination of their total testosterone levels. All men completed the AMS questionnaire to screen for clinical signs of testosterone deficiency. A correlation analysis was performed between the AMS scores with the testosterone level and clinical and laboratory parameters of RA. ROC analysis of the sensitivity and specificity of the AMS questionnaire was performed in comparison with laboratory diagnostics of hypogonadism.

Results. Based on the results of the questionnaire, androgen deficiency was suspected in 70.5%. Hypogonadism (decreased testosterone levels < 12.0 nmol/l) was detected in 33.3% of patients. A significant negative correlation was found between the total score of the AMS questionnaire and all three subgroups of questions with the level of total testosterone. A moderate correlation was noted between age and the sexual symptoms of the questionnaire. The DAS28 index, the number of swollen joints and the level of C-reactive protein significantly positively correlated with the total score of the AMS, as well as with its somatic and psychological components. When conducting the ROC analysis, the area under the ROC curve was 0.728 (95% CI 0.604–0.851; p < 0.001). The threshold value for the AMS questionnaire at the cut-off point was 38.5 points. The sensitivity and specificity of the model were 75.0% and 69.2%. The diagnostic accuracy of the questionnaire was 51.3%, the positive predictive value was 39.3%, and the negative predictive value was 81.8%.

Conclusion. The AMS questionnaire can be effective for diagnosing androgen deficiency symptoms in men with RA, but RA activity makes a significant contribution to the score, which increases the threshold value at which the questionnaire shows satisfactory sensitivity and specificity.

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