Background/Purpose: To evaluate the presence of Precancerous Lesions (PL) in uterine cervix  in patients with Systemic Lupus Erythematosus  (SLE) and its relationship with Human Papillomavirus (HPV). To determine the association between immunosuppressive therapy and the development of PL, and to compare with patients whith Rheumatoid Artrhritis (RA).

Methods: A cross sectional study was conducted. Since May 2011 to July 2012 women sexually active with RA (ACR-EULAR 2010) and SLE (ACR 1992), over 18 years old, were included in the study. They attended consecutively the Rheumatology Unit and they were matched by age with a control group without any rheumatic disease. Gynecological examination included: Papanicolaou test (PAP), Colposcopy (CP) and Polymerase Chain Reaction for HPV (PCR) for 13 genotypes (AMPLICOR Human Papillomavirus test, ROCHE). Pathology and laboratory Units were blind to both determinations.Clinical (DAS 28, HAQ, SLEDAI, SLICC) and therapeutic variables (drug, doses, cumulative doses, period of treatment) were studied.

Results: 172 women were included : 86 patients (48 SLE and 38 RA), mean age 41.4 + 12.1 years and 86 control, mean 38.3 + 11 years. Seventy one (82.5%) patients had normal PAP, while 55 (64%) of the controls had inflammatory PAP; Atypical Squamous Cellls of Undetermined Significance (ASCUS) was found in 5 patients  (2 SLE, 3 RA) vs 8 controls,  Low Grade Squamous Intraepitelial Lesion (LSIL) in 6 patients (5 LES, 1 AR) vs 10 controls and 6 High Grade Squamous Intraepitelial Lesion (HSIL)  only in the control subjects (<0.0001). PCR for HPV was positive in 38.4% (33) patients and in 55% (47) of the control group (p=0.046).  Discriminating by disease, the controls persisted with increasing frequency of HPV (12 RA vs 21 SLE vs 47 controls), p<0.0001. Estimating the prevalence of HPV adjusted to age, we found that RA group was significantly less prevalent, were in SLE and controls was similar. The logistic regression model showed that RA younger patients, had less chance of PCR+. In patients with SLE, LSIL was significantly associated with HPV, whereas in the controls was associated with ASCUS and HSIL (p <0.0001). In RA patients, no association was found between PAP and PCR. The use and accumulated doses of glucocorticoids and immunosuppressive therapy were not associated with HPV (p= NS).

Conclusion: We found no increased frequency of HPV or PL in patients with SLE compared to the control population.  Immunosuppressive therapy was not associated with the presence of HPV

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/human-papillomavirus-and-precancerous-lesions-in-patients-with-systemic-lupus-erythematosus/