Semen analysis of patients with psoriatic arthritis, axial spondyloarthritis and healthy controls

To evaluate semen quality in men with psoriatic arthritis (PsA) or axial spondyloarthritis (AxSpA) compared to healthy controls (HC) and to investigate the effect of disease activity and disease-modifying antirheumatic drugs (DMARDs) on semen parameters.

Consecutive PsA (CASPAR criteria) and AxSpA patients (ASAS criteria) aged 18-50 years either untreated or undergoing treatment with conventional/biologic DMARDs for at least 3 months were prospectively recruited. HC were recruited from candidate sperm donors. All participants underwent clinical assessments, including disease activity scoring. Semen samples collected on the same day as the clinical evaluation were analysed according to WHO 2010 guidelines and for sperm DNA fragmentation index (sDFI).

A total of 102 patients (57 PsA and 45 AxSpA) and 32 HC were included. The semen morphology, concentration, total motile count (TMC) and sDFI were comparable between patients and HC, while vitality was slightly lower in the patients' samples (81.2±7.6 vs. 84.4±4.5 for HC, p=0.02), although still within WHO normal range (>58%). Disease activity states did not affect semen parameters. Concentration and TMC values were lower in patients receiving conventional or biologic DMARDs monotherapy compared to untreated patients and those on combination therapy (p<0.05), but within normal ranges, and all other parameters were normal.

Semen quality in men with PsA and AxSpA is comparable to that of HC. Neither disease activity nor anti-rheumatic drugs substantially affected sperm parameters. These findings are reassuring regarding potential effects on male reproductive health, although confirmation from longitudinal studies is warranted.