Cervical Dysplasia Often Seen in Lupus Patients


LONDON — Women with lupus face an elevated risk of having cervical dysplasia, but the underlying cause of such pathology is still unclear, Michelle T. McHenry, M.B., said at the sixth European Lupus Meeting.

Unlike the situation for healthy women, there appeared to be no association between cervical dysplasia and other traditional risk factors, such as a history of sexually transmitted disease, in a cohort of 221 women who had systemic lupus erythematosus (SLE). The women were identified through hospital records and the Northern Ireland pathology database.

Among this entire cohort, 74 (33%) had a lifetime history of having had at least one abnormal cervical smear, Dr. McHenry reported.

Of those, 45% had had more than one abnormal smear and 26% had had a high-grade abnormality, she said.

From the entire cohort, 141 patients agreed to participate in a study that involved answering a risk factor questionnaire and providing a current cervical smear.

Adequate smears were obtained from 133 patients.

Low-grade abnormalities were found on 22 (17%) of these smears, which is twice the expected incidence, according to the Northern Ireland department of health statistics. High-grade abnormalities were identified on six (5%), which is three times the expected incidence, said Dr. McHenry, a rheumatologist at Queen's University Musculoskeletal Education and Research Unit, Belfast.

The abnormality was detected after the time of diagnosis of lupus in 63% of patients.

“Patients with SLE are at increased risk of cervical cancer but the reasons why are unclear, whether it is related to having the disease itself, to having active disease, [or] to the treatments we administer, or if traditional cervical cancer risk factors have a part to play,” Dr. McHenry said.

“When we assessed these patients for traditional cervical cancer risk factors, we found they were more likely to have had more sexual partners and more children,” she said at the meeting, which was sponsored by the British Society for Rheumatology.

There also was an increased risk of having a cervical smear abnormality among patients who had more active disease as reflected by the Systemic Lupus Activity Measure (SLAM) score, she said.

Other risk factors, including age at first sexual contact and history of ever having used oral contraceptives, were not associated with increased risk of cervical dysplasia.

“And surprisingly, there was no association between abnormal cervical smear history and tobacco smoking,” she said. (See chart.)

Although a correlation was seen between high disease activity scores and history of cervical smear abnormality, there was no correlation with lupus damage scores or duration of disease.

Exposure to corticosteroids and immunosuppressive agents also did not differ between patients with normal cervical smear histories and those with abnormalities, she said.

Further analyses will consider cumulative immunosuppressive doses and will compare human papillomavirus DNA findings between lupus patients and controls, she said.

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