OBJECTIVES:This systematic review and meta-analysis examined how axial spondyloarthritis (axSpA), and its specific disease features, impact sexual function. METHODS:Systematic review of medical literature databases PsycINFO, CINAHL, MEDLINE, Embase, and Cochrane Central from their inception to February 2025. Studies reporting sexual function outcomes in men or women with axSpA were included. After narrative synthesis of included studies, random-effects meta-analysis was used to pool a subset of outcomes. Study quality was assessed using a modified version of the ROBINS-E tool. RESULTS:From the initial 342 identified studies, 37 were included. Nineteen (50%) examined sexual function in men only, 13 (34%) across both genders, five (13%) in women only, and one (3%) did not specify. Nine studies (24%) reported general sexual dysfunction prevalence in people with axSpA, ranging from 32% to 71%. A meta-analysis of studies (n = 4) examining the International Index of Erectile Function in men with axSpA found that all domain scores, except sexual desire, were worse compared with controls. In women with axSpA, a meta-analysis (n = 4) of Female Sexual Function Index data revealed significantly poorer total sexual function scores, and arousal, pain, lubrication and desire sub-domain scores compared with controls. CONCLUSION:Between one- to two-thirds of people with axSpA report a sexual dysfunction. Pooling of data from a small subset of studies demonstrated statistically, and at times clinically, poorer sexual function scores in both men and women compared with controls. This conclusion is constrained by a lack of high-quality research and a notable scarcity of data concerning women.

Abstract Objectives COVID-19 led to rapid uptake of digital health care. We sought to examine digital access, health and digital literacy, and impact on confidence and satisfaction with remote consultations in people with inflammatory rheumatic diseases (IRDs). Methods People with IRDs (n = 2024) were identified from their electronic health record and invited to participate in a cross-sectional survey, using short message service (SMS) and postal approaches. Data were collected on demographics, self-reported diagnosis, access to and use of internet-enabled devices, health and digital literacy, together with confidence and satisfaction with remote consultations. Ethical approval was obtained (Ref 21/PR/0867). Results Six hundred and thirty-nine (639) people completed the survey [mean (s.d.) age 64.5 (13.1) years, 384 (60.1%) female]. Two hundred and eighty-seven (44.9%) completed it online. One hundred and twenty-six (19.7%) people reported not having access to an internet-enabled device. Ninety-three (14.6%) reported never accessing the internet; this proportion was highest (23%) in people with RA. One hundred and seventeen (18%) reported limited health literacy. Even in those reporting internet use, digital literacy was only moderate. People with limited health or digital literacy or without internet access were less likely to report confidence or satisfaction with remote consultations. Conclusion Limited health and digital literacy, lack of digital access and low reported internet use were common, especially in older people with RA. People with limited health literacy or limited digital access reported lower confidence and satisfaction with remote consultations. Digital implementation roll-out needs to take account of people requiring extra support to enable them to access care digitally or risks exacerbating health inequalities.