Doctors in a new study are warning of the higher risk of abnormal Pap smears in women diagnosed with systemic lupus erythematosus (SLE). Abnormal Pap smears raise the risk of cervical cancer. Published in the journal Arthritis & Rheumatism last month, the study examined how often women with SLE had a normal Pap smear compared to those without the disease.1
As a result of the higher risk they found, doctors at Chinese University in Hong Kong who conducted the analysis recommend cervical screening at least once per year for all women with lupus.
A Cause of Pulmonary Hypertension
Systemic lupus erythematosus, also known simply as lupus, can occur in people with secondary pulmonary hypertension, though less often than in those with emphysema and bronchitis.2 Unlike primary pulmonary hypertension, which occurs for no apparent cause, secondary pulmonary hypertension occurs as the result of an underlying disease.
SLE is a chronic rheumatic disease that affects joints, muscles and other parts of the body. Chronic inflammation is a common symptom, and the heart, lungs, skin, joints, blood-forming organs, kidneys and nervous system can be adversely affected. In addition to inflammation, other symptoms include rash on the face, neck, or chest; sunlight sensitivity; oral ulcers; arthritis; inflammation around the lining of the heart, lungs or abdomen; anemia; a depressed immune system; and problems with the kidneys and central nervous system.3
In their study led by Dr. Lai-Shan Tam in the department of Medicine and Therapeutics, the investigators compared the rate of abnormal Pap test results in a group of 85 women with lupus with that of nearly 2,100 women without the disease.
Measuring Other Risks in Lupus
A Pap test checks for the presence of cancerous or precancerous cells in the cervix or vagina, as well as other vaginal or uterine infections. One of those infections is caused by HPV, a virus that can be linked to cervical cancer.4 Tam's team checked for HPV in the patients, as well.
At the conclusion of their study, the Chinese investigators found that the rate of abnormal Pap smears in women with SLE was 16.5% compared to just 5.7% in the healthy population. The researchers also found that the rate of squamous intraepithelial lesions (an abnormal cell found in the cervix that could be precancerous) was almost 6 times higher in lupus patients compared to those without the disease (11.8% vs 2%). "SLE itself remained an independent risk factor for abnormal Pap smears," Tam and her colleagues wrote.
"The overall prevalence of HPV infection in SLE patients and controls was 11.8% and 7.3%, respectively," they added. About 10 percent of the patients with lupus were infected with at least one form of high-risk HPV, compared to only 4.2 percent of those in the group without SLE.
In addition to lupus, other risk factors for an abnormal Pap smear included a history of sexually transmitted diseases (STDs), HPV infection, four or more sexual partners, early age of first sexual activity, and low education level.
Based on the results, physicians should be "vigilant" about the risk of HPV in their patients with lupus. She added that women with high-risk forms of HPV should undergo a Pap smear every 6 months instead of just once per year.
1. Tam LS, Chan AY, Chan PK, Chang AR, Li EK. Increased prevalence of squamous intraepithelial lesions in systemic lupus erythematosus: association with human Papillomavirus infection. Arthritis Rheum 2004 Nov;50(11):3619-25.
2. Pulmonary Hypertension Association. What is PH?
3. Arthritis Foundation. Lupus/Systemic Lupus Erythematosus.
4. American Association for Clinical Chemistry. Pap Smear: The Test.
John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include coverage of health news for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.
