Systemic Lupus Erythematosus
Risk factors for squamous intraepithelial lesions in systemic lupus erythematosus: A prospective cohort study
Version of Record online: 28 JAN 2011
Copyright © 2011 by the American College of Rheumatology
Arthritis Care & Research
Volume 63, Issue 2, pages 269–276, February 2011
How to Cite
Tam, L.-S., Chan, P. K. S., Ho, S. C., Yu, M.-Y., Yim, S.-F., Cheung, T.-H., Wong, M. C. S., Cheung, J. L. K. and Li, E. K. (2011), Risk factors for squamous intraepithelial lesions in systemic lupus erythematosus: A prospective cohort study. Arthritis Care Res, 63: 269–276. doi: 10.1002/acr.20367
- Issue online: 28 JAN 2011
- Version of Record online: 28 JAN 2011
- Accepted manuscript online: 1 OCT 2010 02:08PM EST
- Manuscript Accepted: 17 SEP 2010
- Manuscript Received: 2 FEB 2010
- Chinese University research grant
- Food & Health Bureau of the Hong Kong SAR Government
- Research Fund for the Control of Infectious Diseases
We undertook a prospective cohort study to ascertain the risk factors for the development of squamous intraepithelial lesions (SIL) in patients with systemic lupus erythematosus (SLE).
One hundred thirty-seven SLE patients with a normal Papanicolaou (Pap) smear at baseline were evaluated at 6-month intervals for up to 3 years. At each visit, a Pap smear, human papillomavirus (HPV) DNA test, and clinical assessment were performed.
Among the 137 patients, there were 12 incident cases (8.8%) of SIL over a median followup duration of 30.7 months (interquartile range 25.5–31.7). Among the 30 patients with HPV infection detectable by DNA testing at baseline, 9 (30%) developed SIL. The independent risk factors for the incident SIL in this group of SLE patients included the use of cyclophosphamide (CYC) ever (odds ratio [OR] 5.6, 95% confidence interval [95% CI] 1.1–29.3; P = 0.041) and persistent high-risk HPV infection (OR 26.9, 95% CI 3.2–222.3; P = 0.002). The use of baseline HPV testing has a higher sensitivity than abnormal cytology (defined as atypical squamous cells of undetermined significance; 47.7% versus 33.3%) in predicting the development of SIL.
Independent risk factors associated with the development of SIL in SLE patients included persistent high-risk HPV infection and the use of CYC. Low-risk patients who receive negative test results on both cervical cytology screening and HPV DNA testing may not need to be rescreened within 3 years.