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The aim was to examine the risk of cervical neoplasia in women with SLE, overall and with respect to treatment, compared with women from the general population.
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The main outcome was defined as a first cervical neoplasia dysplasia or cancer during follow-up. Secondary outcomes were first cervical intraepithelial neoplasia CIN 1; first CIN grades 2—3; and first invasive cervical cancer during follow-up — Cox regression models estimated relative risks adjusted for age, level of education, health-care utilization, number of children, marital status, family history of cervical cancer and prior cervical screening.
The subcohort treated with other immunosuppressants was at highest risk of cervical neoplasia. SLE is a risk factor for cervical neoplasia, in particular for pre-malignant cervical lesions.
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Among patients with SLE, the risk is higher among those treated with immunosuppresants compared with those treated with antimalarials. Keywords: systemic lupus erythematosus, cervical cancer, immunosuppressants, antimalarials, cohort study, registers, epidemiology, reproductive, DMARDS, viruses. Rheumatology key messages Women with SLE appear to be at increased risk of cervical neoplasia.
- Interleukin 1β is a proinflammatory cytokine that plays a critical role in chronic inflammation and carcinogenesis.
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- In each group of lesions with cribriform architecture benign, premalignant and malignant intraductal or infiltratingthere are situations in which histological classification of the lesion is difficult or impossible on routine stains.
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Treatment with systemic immunosupressants is a marker of higher risk among women with SLE. Introduction SLE demonstrates a marked female predominance, is associated with numerous immunological aberrations involving both innate and adaptive immunity [ 1 ], and is typically treated with various immunomodulatory regimens. Several studies have suggested that an increased risk of cervical neoplasia in SLE is, at least in part, attributable to the immunosuppressive treatment [ 34 ].
Previous studies have suggested a small increase in the overall burden of cancer in SLE [ 5—7 ], but the risks for cervical pre-malignancies and invasive cancer are less well understood.
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Studies to date have suggested suboptimal use of screening in women with SLE and an increased risk of cervical dysplasia [ 89 ], but whether there is an increased risk for invasive cervical cancer remains unclear [ 510 ]. In light of the immunological aberrations associated with SLE, the immunomodulatory drugs used to treat it, and the fact that the risk of cervical neoplasia can be effectively reduced by HPV vaccination and cervical cancer screening warts on foot 1112 ], a better understanding of these risks is of direct clinical relevance.
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The aim of this study was therefore to assess the incidence of pre-malignant and invasive cervical malignancies in women with SLE, and to compare these risks with those in the general population. Women with SLE were considered overall and as defined by treatment exposures.
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Methods Study design We performed a nationwide cohort study with follow-up from January to Decemberusing population-based data from Swedish national registers on patients with SLE, cervical cancer screening and invasive cervical cancer.
Setting and data sources Swedish health care is public and tax funded.
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All Swedish residents are assigned a personal identification number, which allows for linkage between registers. This study was based on the Swedish Lupus Linkage cohort, which has been described in hpv causes inflammation elsewhere [ 13 ].
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Briefly, the National Patient Register NPR contains data on hospitalizations since and outpatients visits in specialized care sinceand lists main and contributory diagnoses, dates of admission and discharge, hospital and department. The Swedish Cancer Register began in and captures the mandatory reporting of incident cancers along with date, diagnosis, site of tumour, tumour stage and tumour histology.
Cervical cancer is staged according to hpv causes inflammation International Federation of Gynecology and Obstetrics classification system. During the study period, all women living in Sweden were invited to cervical screening every 3 years between ages 23 and 50 years, and every 5 years between ages 51 and 60 years.
The Cause of Death Register records the date and underlying and contributory causes of death.
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The Total Population Register contains information on residency and dates of immigration or emigration for all residents in Sweden since The Multigeneration Register contains information on parents and children cum să recunoaștem papilomul those born in Sweden in or later and those registered in Sweden at some time since Siblings can be identified by listing all persons with the same biological parents.
The date of the second SLE-coded visit served as the start of follow-up.
Drug-induced lupus ICD M Within the full SLE cohort, we identified two nested and overlapping subcohorts based on medication dispensing.
The first subcohort consisted of patients treated with antimalarials who had at least one dispensing of HCQ or chloroquine phosphate. The start of follow-up was defined as the date when all inclusion criteria were fulfilled i.
Any dispensing for immunosuppressant medications listed below resulted in exclusion if prior to the start of follow-up, and censoring and subsequent switching of subcohorts if following the start of hpv causes inflammation therapy.
The start of follow-up was defined as the date when all of the SLE diagnoses and date of first immunosuppressant dispensing criteria were fulfilled. Person-time in this subcohort was classified as once exposed, always exposed. Through Statistics Sweden, comparator subjects from the general population were identified and matched to each individual with SLEon sex, year of birth and county of residence.