As Teenage Girls with Lupus Mature
- Inflammatory cervicovaginal cytology is associated with disease activity in juvenile systemic lupus erythematosus
- Lupus, Volume 16, Number 6, June 2007, pp. 430-435
What is the topic?
This is one of the first studies that focused on vaginal infections and cervical changes in adolescent females with juvenile lupus.
What did the researchers hope to learn?
There is some research showing that adult women with lupus are at greater risk for abnormalities of the cervix. This risk may be heightened because they are more susceptible to infections -- including HPV, the human papilloma virus that has been linked to cervical cancer -- either from their disease or the immunosuppressive medications that take to control it. The researchers for this study wanted to see if this risk also applied to adolescent lupus patients.
Who was studied?
Fifty-two female juvenile lupus patients between the ages of 10 and 19 at a rheumatology clinic in Brazil and another fifty-two healthy females (i.e., no juvenile lupus) of similar ages were selected for this study. All of the study subjects had to have begun menstruating in order to participate.
How was the study conducted?
Each of the 104 study subjects had a vaginal examination and Pap smear test; the Pap smear test can show if there are any abnormal cells or signs of inflammation in the vagina or cervix. The researchers also collected information regarding the age at which each of the young women began menstruating, their sexual activity, and their use of contraception.
What did the researchers find?
There was no difference in the number of abnormal PAP smears among the two groups, those with or without lupus; fifty percent of each group had normal results. Nor was there any significant difference between the two groups in terms of the number who showed inflammatory changes in the cervix. However, within the group of patients who had lupus, those who had more lupus disease activity were twice as likely to have inflammatory changes in their cervix.
One interesting finding in the results concerned the kinds of vaginal infections that were found. Seven of the lupus patients showed evidence of candida, a kind of yeast infection which is often exacerbated by immune-suppressing treatments, especially prednisone. No candida infection showed up among the non-lupus group. All seven of those lupus patients with candida had inflammatory changes in their Pap smears, and each of them was on one or more immunosuppressive drugs and was taking higher doses of prednisone than the lupus patients in the study who did not have candida.
Though cervical abnormalities in adolescents are related to sexual activity, the researchers felt that their data could suggest that lupus on its own (or the treatments given) can contribute to higher risk for cervical inflammation -- in particular their findings that higher lupus disease activity was related to more changes on the Pap smear test, even among patients who were not sexually active.
What were the limitations of the study?
This study has some interesting findings, but there are also lots of questions. Though all of the lupus patients who had candida were on immunosuppressive medications, the researchers chose to downplay this when they pointed to lupus disease as the risk factor.
What do the results mean for you?
Despite the questions surrounding this study, the researchers have provided enough evidence to suggest that lupus patients may be at risk for vaginal inflammation even if they don’t engage in sexual activity. Teenage girls with lupus should be encouraged to have Pap smears taken during their adolescent years, especially if they have a level of disease activity that requires high doses of prednisone or immunosuppressive medications. It is possible that if the virus that causes cervical cancer does infect a person who has pre-disposing cervical information (from candida or other causes) it might cause increased problems.