Evaluation of the effectiveness of the AMS questionnaire for screening hypogonadism in men with ankylosing spondylitis

Introduction. Due to the fact that a significant proportion of patients with ankylosing spondylitis (AS) are men, the study of reproductive health, in particular the clinical diagnosis of hypogonadism syndrome, is a pressing issue.
Aim. To evaluate the sensitivity and specificity of the Aging Male Symptoms (AMS) questionnaire for diagnosing hypogonadism in patients with AS.
Materials and methods. A cross-sectional continuous study included 82 men with AS who were undergoing inpatient treatment at the V.A. Nasonova Research Institute of Rheumatology. The patients underwent determination of their total testosterone levels and subsequent division into subgroups with normal (≥12.0 nmol/l) and reduced 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 testosterone levels and clinical and laboratory parameters of AS. ROC analysis of the sensitivity and specificity of the AMS questionnaire was performed in comparison with laboratory diagnostics of hypogonadism in patients of this sample.
Results. Based on the results of the questionnaire, androgen deficiency symptoms were suspected in 87.8%. Hypogonadism (testosterone level decreased to less than 12.0 nmol/l) was detected in 13.4% of patients. There was a complete absence of significant correlations between the testosterone level and the total score, as well as individual components of the AMS questionnaire. There were significant positive correlations (mainly for the total score and somatic questions) with the BASDAI and ASDAS activity indices, positive correlations between individual components of the AMS questionnaire and the levels of C-reactive protein and ESR. The sexual component of the AMS questionnaire had a significant positive correlation with the duration and stage of AS, functional class, and all vertebral indices. When conducting the ROC analysis, the area under the ROC curve was 0.558 (95% CI 0.386–0.729; p = 0.54).
Conclusion. The AMS questionnaire showed low sensitivity and specificity for diagnosing androgen deficiency symptoms in men with AS, which may be due to the significant contribution of AS activity and functional disorders to its results.

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