Background Systemic Lupus Erythematosus (SLE) is a prototype of autoimmune disease that is characterized by multisystem involvement and production of multiple auto-antibodies that underwent tissue deposition and cause chronic inflammation. Some studies have suggested that the lupus patients have and increased risk of malignancies such as lymphoma, sarcoma and breast cancer. The risk of cervical dysplasia or an abnormal pap smear in women with SLE seems to be increased but in our country there is scanty data about the frequency of cervical abnormalities.
Objectives The purpose of this study was to determine the occurrence of cervical dysplasia and Pap smear abnormalities in patients with systemic lupus erythematosus.
Methods Cross-sectional study was performed, 30 women with SLE, according to ACR criteria, were included and we compared them with eighty-three historical controls from de data base of gynecological department. The clinical activity of SLE was measured with MEX-SLEDAI. Pap smear was done in the two groups and the patients with suspicious lesions on the cervix underwent colposcopy and cervical biopsy. Statistics analysis was done by using arithmetic mean, standard deviation, Mann-Whitney U test for comparison of groups and multivariate logistic regression for correlation, chi-square and Exact Fisher test for categorical variables, the program we used was SPSS (v 12.0).
Results The frequency of cervical dysplasia in the SLE group was 23% versus 10% in the control group; the risk of intraepithelial dysplasia for SLE patients was OR 2.85 (IC 95% 1.93 to 8.71). When we did adjusted multivariate analysis, no association was found between cervical dysplasia and age of beginning the sexual life, the number of sex partners, the time of evolution of the disease, the use of corticosteroids or the immunosuppressive drug therapy. No correlation with clinical activity of SLE and cervical dysplasia. In a sub-analysis the infection by human papillomavirus was more frequent in the SLE group, 30% vs 4%, but we did not identified more risk of cervical dysplasia in the former patients OR 0.88 (IC 95% 0.22 to 0.352)
Conclusions This work demonstrated that patients with SLE have more risk of cervical dysplasia than general population; we suggest that the epidemiological surveillance of this group of patients should be more careful, with pap smear more early in life and probably every 6 months apart.
Klumb EM, Araujo ML Jr, Jesus GR, Santos DB, Oliveira AV, Albuquerque EM, Macedo JM. Is higher prevalence of cervical intraepithelial neoplasia in women with lupus due to immunossuppresion? J Clin rheumatol 2010 oct; 16 (7): 355.
Disclosure of Interest None Declared
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