ABNORMAL PAP TESTS IN SYSTEMIC LUPUS ERYTHEMATOSIS: A CYTOPATHOLOGICAL AND HUMAN PAPILLOMAVIRUS TESTING STUDY.

Objectives: the frequency of cervical squamous intra-epithelial lesions (SIL) in women with systemic lupus erythematosus (SLE), and the association between clinical parameters, use of immunosuppressant agents, human papillomavirus (HPV) infection, colposcopy, and development of SIL in SLE. Methods: A retrospective case control study conducted in 150 women constituted the study group with confirmed diagnosis of SLE. The enrolled patients divided into study group (no.28) with abnormal pap smears and reference group (no.122) with normal pap smears. All patients subjected to clinical evaluation, colposcopy, directed biopsies, and HPV-ISH testing. All participants reassessed every 6 months for 2 years. Results: mean patient age with abnormal pap smears was 44.8(P = 0.74) years with mean SLE disease duration was 9.3±7.1 years. There was past history of cervical lesions where it was positive in 89.3% (P = 0.001). SLE patients with abnormal pap smears showed significant difference regarding nephritis (P = 0.001) and high titers of Anti-double stranded DNA (P = 0.001) and Antiphospholipid antibodies (P = 0.012). SLEDAI, SDI, and immunosuppressant agent usage found significantly different among patients with abnormal pap smears. HPV Infection found significantly important (P = 0.001) when the infection was high-risk HPV, multiple HPV, or persistent HPV infection among patients with abnormal pap smears. On comparison with cytology, colposcopy, HPV-ISH results, the best sensitivity was with the use of HPV-ISH (90%) then with colposcopy (75%). In addition, the best specificity was with the use of colposcopy (99%). The highest positive predictive value was with colposcopy (94%) and the highest negative predictive value was with HPV-ISH assay (98%). Conclusion: Patients with SLE had higher risk for HPV infection and cervical dysplasia than the general population. Thus, gynecological visits at shorter intervals (3-6 months) recommended for those patients. The use of colposcopy is useful tool in areas where the screening of HPV is not available.