Background/Purpose: Women with systemic rheumatic diseases (SRDs), particularly those with SLE, may be more vulnerable to HPV infection and HPV-related cervical cancer. However, HPV testing and vaccination rates are low in patients with SLE (Dhar et al. J. Clin Rheumatol. 2019). We aimed to assess and compare HPV vaccination status and awareness in female rheumatology patients with systemic lupus erythematosus (SLE) vs. rheumatoid arthritis (RA).

Methods: Women aged 18-65 years seen by a Hospital for Special Surgery rheumatologist ≥2 times between 2020-2022 were recruited to the Rheumatology Women’s Reproductive Health and Wellness Cohort; cohort enrollment is ongoing. This interim analysis included cohort members self-reporting rheumatologist-diagnosed SLE or RA (excluding those reporting both) who responded to questions on rheumatology history, reproductive history, and HPV vaccination awareness. We compared reproductive history and HPV vaccination status and awareness in women with SLE vs. RA.

Results: Of the 812 cohort participants, 711 (87.6%) completed the relevant questionnaires. This analysis included 295 participants: 111 with SLE and 184 with RA. Demographics were similar between the two groups, except those with SLE were younger (45.6 vs. 49.0 years, p=0.02). Women with SLE and RA were similarly likely to be sexually active, report a prior Pap smear, and report similar time since their most recent Pap smear (Table 1). While the two groups had numerically but not statistically different rates of abnormal Pap smears (42.9% vs. 32.8%, p=0.09), women with SLE were more likely to have persistent abnormal smears on follow up (13.3% vs. 1.7%, p=0.04). Gynecologic diagnoses were similar between groups, except two women with SLE and none with RA reported cervical cancer diagnoses (Table 1). Although more women with SLE discussed cervical cancer screening with their rheumatologist (33.3% vs. 11.4%, p< 0.01), women with SLE and RA were similarly due/overdue for cervical cancer screening. HPV vaccination uptake was similar between the groups, with 37% of previously/currently eligible women having completed the vaccine series. Of the 50% of previously/currently eligible women never beginning vaccination, 90% reported it not being offered. Both groups responded similarly to HPV vaccination awareness questions (Table 2).

Conclusion: Compared to women with RA, women with SLE at our tertiary musculoskeletal center reported a higher frequency of persistent abnormal Pap smears and were more likely to have discussed cervical cancer screening with their rheumatologists. Among women previously/currently eligible for HPV vaccination, 37% completed the vaccine series with no difference in vaccination rate or awareness between women with SLE and RA. Among the 50% of previously/currently eligible women who did not begin HPV vaccination, 90% reported never having been offered the vaccine although vaccination may have been warranted for those >26 years in certain instances (e.g. immunosuppressive medication use) based on expanded eligibility criteria. Our results suggest the importance of increasing both HPV vaccination and cervical cancer screening discussion in women with SLE and RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/reproductive-history-and-hpv-vaccination-awareness-among-women-with-systemic-lupus-erythematosus-and-rheumatoid-arthritis/