Cervical human papillomavirus status among women with chronic inflammatory rheumatic diseases: matched cohort study

Women with chronic inflammatory disorders such as rheumatoid arthritis (RA) and spondyloarthritis (SpA) are at increased risk for cervical precancer (CIN2+). It is unknown whether their human papillomavirus (HPV) status differs compared with a general screening population.

To determine whether cervical screening reliant on HPV16/18 detection would be appropriate also in RA/SpA.

We included women with (1) RA (n = 53 816) or (2) SpA (n = 25 496) who were naïve to biologic-/targeted synthetic-disease-modifying anti-rheumatic drugs (b/tsDMARD), (3) women with RA (n = 14 033) or (4) SpA (n = 8297) starting a first b/tsDMARD, and matched (1:5) general population comparators, n = 504 290). Incident HPV infection was categorized as positive for HPV16/18, and/or other (non-16/18) HPV types. Relative risks (RRs) were assessed through log-binomial regression.

Women with RA, whether exposed to b/tsDMARDs or not, had a higher prevalence of HPV (statistically significant RR of 1.17-1.18 vs comparators). Among women with SpA, risks were elevated in b/tsDMARD-exposed, as were other (non-16/18) HPV types. B/tsDMARD-naïve women with RA (but not those with bionaïve SpA) had higher risk for CIN2+ than comparators (RR = 1.20, 95% CI = 1.07 to 1.34). However, the proportion of women with CIN2+ positive for HPV16/18 or other HPV types did not differ vs comparators, neither in RA nor in SpA and whether b/tsDMARD-exposed or not.

Although some women with RA or SpA have higher risks for HPV and CIN2+ than the general population, their proportions of HPV16/18 vs other HPV types in CIN2+ do not differ. This is reassuring for cervical screening risk-stratifying women based on HPV16/18 detection.