Background/Purpose: Cervical human papillomavirus (HPV) infection has been observed in 28% of rheumatoid arthritis (RA) patients in a cross-sectional study with no available data regarding Chlamydia trachomatis (CT) infection. Anti-TNF blockage may increase the risk of these gynecologic complications, in spite of a few case reports of HPV infection in chronic inflammatory arthritis and psoriasis under this therapy. Therefore, the purpose of our study was to evaluate HPV and CT infections in RA patients pre- and 6 months post-TNF blocker. The possible associations among these infections, demographic data, sexual function, disease parameters and treatment were also analyzed.

Methods: Fifty female RA patients (ACR criteria), who were eligible to anti-TNF therapy, [n=50 at baseline (BL) and n=45 after 6 months of treatment (6M)] and 50 age-matched healthy controls were prospectively enrolled. All RA patients and controls had previous sexual activity. Exclusion criteria were: current pregnancy, early post-partum period, diabetes mellitus, psychiatric diseases and cervical cancer. They were assessed for demographic data, gynecologic, sexual, cervical cytology and histological evaluations, disease parameters and current treatment. HPV DNA and CT DNA testing in cervical specimens were done using Hybrid Capture II assays. 

Results: At BL, the median current age of RA patients and controls was 49(18-74) vs. 49(18-74) years, p=1.0. A trend of lower frequency of HPV infection was observed in AR patients pre anti-TNF compared to controls (14% vs. 30%, p=0.054). None of patients had genital warts. Further evaluation of AR patients with and without HPV infection before anti-TNF therapy showed that the former group had a higher frequency of sexual intercourses (100% vs. 48%, p=0.014), higher median number of sexual partners [1(1-1) vs. 0(0-1), p=0.032] and higher frequency of abnormal cervical cytology (43% vs. 7%, p=0.029). Current age, disease duration, physician and patient visual analogue scales, DAS 28, ESR, CRP and treatments were alike in both groups (p>0.05). At 6M after TNF blockage, HPV infection remained unchanged in five patients, whereas two became negative and one additional patient turn out to be positive (McNemar´s test p=1.0). None of them had cervical cancer in Pap smear. CT infection was uniformly negative in RA patients pre- and post-TNF blockage and in controls. 

Conclusion: To our knowledge, this was the first study to assess prospectively genital infections in RA patients under TNF blockage therapy. Anti-TNF does not seem to increase short-term risk or severity of HPV and CT infections in RA patients.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/human-papilloma-virus-and-chlamydia-trachomatis-infections-in-rheumatoid-arthitis-under-anti-tnf-therapy/