Annals of the Rheumatic Diseases

Risk of HPV-associated precancer and cancer in women with systemic lupus erythematosus

We aimed to compare the occurrence of human papillomavirus (HPV)-associated precancer and cancer in a nationwide cohort of women with systemic lupus erythematosus (SLE) with general female population rates. In the nationwide Patient Registry, we identified all women in Denmark with a first diagnosis of SLE recorded during 1996-2021 (N = 5092). The cohort was followed up in nationwide registries for HPV-associated precancer and cancer until 2022. Standardised incidence ratios (SIRs) were computed with 95% CIs overall and stratified by age at SLE diagnosis and follow-up time. Compared with general population rates, women with SLE had increased rates of cervical (SIR, 2.3; 95% CI, 2.0-2.7), vaginal (SIR, 4.3; 95% CI, 1.1-9.5), vulvar (SIR, 3.7; 95% CI, 2.3-5.5), and anal (SIR, 4.3; 95% CI, 1.7-8.1) precancers. Increased cancer rates were observed for cervix, anus, and oropharynx, but only the SIR for oropharyngeal cancer was near statistical significance (SIR, 2.5; 95% CI, 0.9-4.9). The increased SIRs for precancers and cancers sustained throughout follow-up and were higher in women diagnosed with SLE at age <50 years compared with ≥50 years, but CIs were overlapping. Women in this nationwide SLE cohort had twice the risk of cervical precancer (vs the general population) and up to 5-fold increased risk of the individual noncervical anogenital precancers. Rates of oropharyngeal cancer and the anogenital cancers were not statistically significantly increased; however, estimates were based on few cases.

Update οn the diagnosis and management of systemic lupus erythematosus

Clinical heterogeneity, unpredictable course and flares are characteristics of systemic lupus erythematosus (SLE). Although SLE is-by and large-a systemic disease, occasionally it can be organ-dominant, posing diagnostic challenges. To date, diagnosis of SLE remains clinical with a few cases being negative for serologic tests. Diagnostic criteria are not available and classification criteria are often used for diagnosis, yet with significant caveats. Newer sets of criteria (European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019) enable earlier and more accurate classification of SLE. Several disease endotypes have been recognised over the years. There is increased recognition of milder cases at presentation, but almost half of them progress overtime to more severe disease. Approximately 70% of patients follow a relapsing-remitting course, the remaining divided equally between a prolonged remission and a persistently active disease. Treatment goals include long-term patient survival, prevention of flares and organ damage, and optimisation of health-related quality of life. For organ-threatening or life-threatening SLE, treatment usually includes an initial period of high-intensity immunosuppressive therapy to control disease activity, followed by a longer period of less intensive therapy to consolidate response and prevent relapses. Management of disease-related and treatment-related comorbidities, especially infections and atherosclerosis, is of paramount importance. New disease-modifying conventional and biologic agents-used alone, in combination or sequentially-have improved rates of achieving both short-term and long-term treatment goals, including minimisation of glucocorticoid use.