Background There is concern that women with rheumatoid arthritis (RA) are at increased risk of high-grade cervical dysplasia (HGCD) detected via cervical smear. There is also controversy regarding the effect of chronic disease/disability on routine cancer screening attendance in this population.
Objectives To (1) compare uptake of cervical screening for women with RA in the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis (BSRBR-RA) with the general population and (2) compare frequency of HGCD between RA and the general population and between patients with RA ever versus never exposed to biologics.
Methods The BSRBR-RA, a prospective cohort study, was linked to the NHS Cervical Screening Programme England (CSPE). Data from 2004–2014 was analysed in line with CSPE methods who publish coverage analysis annually; coverage is defined as the number of women who have been adequately screened at the defined age-dependent review period out of the total number of women eligible for screening in this period. Annual coverage was calculated for the eligible BSRBR-RA population and compared to national statistics. Within the BSRBR-RA, coverage was also compared between those patients with mild/moderate disability (mean Health Assessment Questionnaire (HAQ) scores <2) and high disability (HAQ ≥2).
Rates of HGCD (moderate dyskariosis or greater) and low grade cervical dysplasia (LGCD, borderline or mild dyskariosis) were compared to rates of negative smears using risk difference calculations between the BSRBR-RA and national statistics, and between the biologic naïve (standard DMARD therapy) and biologic exposed cohorts within the BSRBR-RA.
Results Of 13565 linked records, 12939 women had RA of which 12785 had cervical screening data, 2132 (17%) on nbDMARD therapy and 10653 (83%) with biologic exposure. Between 2004–2014 mean five-year coverage was higher in the BSRBR-RA population at 82.5% (95% CI 81.9, 83.1) compared to 79.0% (95% CI 78.5, 79.6) nationally. This mostly reflects significantly higher age appropriate coverage in the 25–49 year group for the BSRBR-RA population: 77.2% (95% CI 75.9, 78.6) compared to 71.4% (95% CI 70.2, 72.6) nationally. Coverage was higher among women with HAQ <2 (n=6631) compared to those with HAQ ≥2 (n=5163): 85.4% (95% CI 84.7, 86.1) and 78.1% (95% CI 77.3, 78.8) respectively.
The risk of HGCD was lower in the BSRBR (0.9%) compared to the general population (1.3%) with a risk difference of -0.004 (95% CI -0.005, -0.002). The risk of LGCD was higher in the BSRBR (7.5%) compared to the general population (5.4%) with a risk difference of 0.021 (95% CI 0.017, 0.025). There was no significant risk difference for HGCD between the biologic and nbDMARD cohorts at 0.009 (95% CI -0.003, 0.021).
Conclusions Women in the BSRBR-RA in England have higher rates of cervical screening attendance than the general population, although high HAQ scores had a negative effect on screening attendance. Those aged 25–49 years had markedly higher attendance; this may reflect familiarity with accessing healthcare. Cytology analysis suggests lower risk for HGCD in the RA group but higher risk for LGCD; this may reflect increased screening attendance. Women receiving biologic therapy were not at an increased risk of HGCD compared to those receiving standard DMARD therapy.
Disclosure of Interest None declared
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