Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Lupus Disease Severity Is Not a Risk for Cervical Intraepithelial Neoplasia in SLE.
Dhar3, J. Patricia, Gregoire3, Lucie, Lancaster3, Wayne, Stark1, Azadeh, Schwartz3, Ann, Schultz2, Daniel, Essenmacher3, Lynnette
Women with systemic lupus erythematosus (SLE) are at increased risk for cervical intraepithelial neoplasia (CIN), possibly related to immunodysregulation. We hypothesized that women with SLE who developed CIN would be younger, have more severe disease and have received more immunosuppressive treatment.
In a case-control design, clinical characteristics of SLE women with CIN (cases) were compared to two groups of SLE women without CIN (controls). Diagnoses of cervical intraepithelial neoplasia (CIN) were confirmed from formalin fixed blocks of cervical tissue from 113 women with SLE. Clinical data were obtained by chart review. Logistic regression was used to evaluate for any significant differences in clinical variables between the cases and the controls. Two sets of controls were used for comparison with a ~2:1 match for each control group to the cases group. For the first set, only the year of entry into our Lupus Clinic was controlled for ("unmatched" group, n=206); a second non-overlapping control group was matched for age, race, and year of entry into the clinic ("matched" group, n=212). The second matched control group was used to control for the three matching factors to allow smaller, but important effects of other factors, such as lupus severity, to emerge.
For the cases, these predominantly African American (75.2%) women with SLE had a mean age at cervical biopsy of 38.5 years, with low grade CIN (CIN I/II) the most prevalent (80.5%) histology. Logistic regression showed that the cases differed from the both matched and unmatched controls only by being only one to two years younger (32.1 yrs. vs. 33.1 yrs. and 34.1 yrs., respectively) at lupus diagnosis. We did not combine the control groups because they were statistically significantly different from each other. Using the control group matched for age and race, logistic regression analysis showed no significant differences between cases and controls for any of the clinical variables. In particular, there were no significant differences for factors related to SLE (disease severity, use of immunosuppressive drugs, use of corticosteroids alone), chronic metabolic diseases (hypertension, diabetes), and HPV risk factors (marital status, smoking, gravidity, parity). Power analyses for both the unmatched and matched comparisons were similar for both lupus severity and immunosuppressive medications. At these sample sizes, with a two sided test, an alpha=.05 and 80% power, the difference in population proportions detectable was approximately 0.17, which is between a small and moderate difference. None of the described differences approached this magnitude of effect.
The key finding of this study is that SLE patients who develop CIN are not clinically different from SLE patients who do not develop CIN. In particular, worsened disease severity and immunosuppressive treatment do not appear to be susceptibility factors for CIN in SLE. All female SLE patients should be monitored closely for CIN, with at least annual PAP smears.
To cite this abstract, please use the following information:
Dhar, J. Patricia, Gregoire, Lucie, Lancaster, Wayne, Stark, Azadeh, Schwartz, Ann, Schultz, Daniel, et al; Lupus Disease Severity Is Not a Risk for Cervical Intraepithelial Neoplasia in SLE. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :468