Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.

Risk Factors for Squamous Intraepithelial Lesions in Systemic Lupus Erythematosus- A Prospective Cohort Study

Tam1,  Lai-Shan, Chan2,  Paul K., Ho2,  Suzanne C., Yu1,  May M., Yim1,  So-Fan, Cheung1,  Tak-Hong, Wong1,  Martin C.

The Chinese University of Hong Kong, Hong Kong, China,
The Stanley Ho Centre for Emerging Infectious Diseases, Hong Kong, China


In patients with systemic lupus erythematosus (SLE), association between cervical diseases and cyclophosphamide (CY) was controversial. SLE patients with a high human papillomavirus (HPV)-16 viral load more frequently had squamous intraepithelial lesions (SIL). However, the role of other high risk HPV types has not been addressed. We undertook a prospective cohort study to ascertain the risk factors for the development of SIL in patients with SLE.


One hundred and thirty-seven SLE patients with normal pap smear at baseline were evaluated at six-month intervals for up to three years. At each visit, a Pap test, a test for HPV DNA and clinical assessment were performed. HPV DNA detection was performed using the PGMY PCR targeting the consensus region of the HPV L1 gene. HPV typing was done using the Linear Array HPV Genotyping Test that can detect 37 HPV types. Baseline risk factors for development of SIL included sociodemographic, lifestyle, reproductive and gynecologic variables, disease related variables, the use of immunosuppressants and HPV status.


The mean age was 41 +/- 9 years and 55 (36.7%) were postmenopausal. The mean disease duration was 8.6 (4.6–14.4) years. The total follow up duration was 4,066 patient months. Eleven out of 137 (8.0%) patients developed at least one episode of SIL. Amongst the 30 patients with HPV infection detectable by DNA testing at baseline or during follow-up, 9/30 (30%) developed SIL. Univariate analysis showed that the development of incident SIL was associated with the use of azathioprine and cyclophosphamide (CY) (oral, intravenous (IV) or combined) ever, current use of IVCY; HPV infection (pre-existing, incident and ever), multiple HPV infection (pre-existing, during first incident infection and ever), high risk HPV infection (baseline and ever), any persistent HPV infection (since baseline or ever) and persistent high risk HPV infection (ever); previous treatment of cervical lesions, age at first sexual intercourse </=22. Other demographic and clinical parameters, and the use of immunosuppressants were not associated with the development of SIL. All these variables were analyzed using regression analysis. The independent risk factor for the incident SIL in this group of SLE patients included the use of CY ever (p=0.021, OR 3.5, 95% CI 12.2-10.2), persistent high risk HPV infection (p=0.007, OR 12.9, 95% CI 2.0–80.9), and previous treatment of cervical lesions (p=0.028, OR 10.0, 95% CI 1.3–77.9).


Persistent high risk HPV infection, previous treatment of cervical lesions and the use of CY were independent risk factors associated with the development of SIL in SLE patients.


This project forms part of a series of studies commissioned by the Food & Health Bureau of the Hong Kong SAR Government and funded by the Research Fund for the Control of Infectious Diseases.

To cite this abstract, please use the following information:
Tam, Lai-Shan, Chan, Paul K., Ho, Suzanne C., Yu, May M., Yim, So-Fan, Cheung, Tak-Hong, et al; Risk Factors for Squamous Intraepithelial Lesions in Systemic Lupus Erythematosus- A Prospective Cohort Study [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1255
DOI: 10.1002/art.26329

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