Recurrent Pericarditis in Lupus

Jack Cush, MD

Feb 27, 2025 4:14 pm

A study from the Lupus Hopkins Cohort shows that systemic lupus erythematosus (SLE) patients with pericarditis are at risk for recurrence, and likely to be younger patients, with uncontrolled disease, and linkage to higher doses of oral prednisone.

This retrospective analysis of a single-center prospective cohort of SLE patients seen between 1988 and 2023, analyzed those with pericarditis, their predictors and features. Recurrence was defined as episodes occurring at least 6 weeks after the first episode.

The lupus cohort included 2931 patients, of whom 590 (20.3%) had a history of pericarditis. First episode of pericarditis occurred in 257 (44%) patients <30 years, affecting 535 women [90%]; 303 Black [51%] and 253 White [43%]). In only a minority (21 patients or 3.6%) was pericarditis confirmed via electrocardiogram or imaging.

With a median follow-up of 6.7 years, recurrent pericarditis was observed in 20.3% (recurrence rate = 0.053 recurrences per person-year of follow-up). Half of those with recurrence (51%) had only 1 recurrence, wwith the other hallf (49%) having 2 or more recurrences.

Factors significantly associated with recurrence included younger age (RR 0.11); higher dose prednisone (≥20 mg vs 0 mg: RR, 1.99); active SLE disease (SLEDAI ≥3 vs 0: RR, 1.55); and time since the first episode (3-10 years vs <1 year: RR, 0.32).

These findings may prognosticate on the risk and treatment of pericarditis in SLE patients, especially in younger patients with severe active SLE.

Editors note: The authors speculate "oral prednisone therapy should be avoided when treating pericarditis given its association with recurrence", noting other trials have also found steroid use linked to recurrence. They suggested that studies are needed to establish a way forward that isnt dependent on prednisone, especially trials of either colchicine or IL-1 inhibitors. But the possibility exists that this linkage may be confounding by indication, as active, severe SLE and pericarditis patients are likely to be treated with higher doses of corticosteroids.

There are very few trials studying treatment interventions for recurrent pericarditis. Most of these are small cohort reports or trials in non-SLE patients: