Risk factors for squamous intraepithelial lesions in systemic lupus erythematosus: a prospective cohort study.
OBJECTIVE
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).


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Tam
Lai-Shan
LS
Department of Medicine and Therapeutics, The Prince of Wales Hospital and The Chinese University of Hong Kong, Hong Kong, China. tamls_813@yahoo.com
Chan
Paul K S
PK
Ho
Suzanne C
SC
Yu
Mei-Yung
MY
Yim
So-Fan
SF
Cheung
Tak-Hong
TH
Wong
Martin C S
MC
Cheung
Jo L K
JL
Li
Edmund K
EK
D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy; D030361:Papillomavirus Infections / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000453:epidemiology*; D002578:Uterine Cervical Dysplasia / Q000150:complications / Q000453:epidemiology*
D007166:Immunosuppressive Agents