April 02, 2025
3 min read
Key takeaways:
- In patients with lupus, those taking prednisone or demonstrating active disease and a more recent initial episode are more likely to have pericarditis recurrence.
- Overall recurrence was lower than in the general population.
Pericarditis recurrence in lupus is more likely — and has a dose-dependent relationship — with oral prednisone treatment, though overall it is lower than in the general population, according to data published in JAMA Network Open.
“Pericarditis is the most common cardiac complication of systemic lupus erythematosus, yet surprisingly little research has been done on how often it recurs and what factors contribute to recurrence,” Andrea Fava, MD, assistant professor of medicine at Johns Hopkins University, told Healio. “Clinicians frequently see lupus patients experiencing recurrent pericarditis, but there is no clear guidance on how to prevent or manage it effectively.”
To learn more about factors that drive pericarditis recurrence in lupus, Fava and colleagues retrospectively analyzed 590 patients from the Hopkins Lupus Cohort from April 2023 to May 2024. Included patients demonstrated a history of pericarditis when they entered the cohort, or be subsequently diagnosed using criteria from the Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SELENA-SLEDAI).
The researchers classified pericarditis as recurrent when it happened at least 6 weeks after the first episode, with patients contributing multiple recurrences if they occurred at least 6 weeks apart. Pooled logistic regression models were used to calculate rate ratios for recurrent pericarditis, with generalized estimating equations to account for multiple recurrences among some patients.
Overall, 20.3% of patients (n = 120) demonstrated recurrent pericarditis — most of whom (n = 61) had one recurrence — over a median follow-up period of 6.7 (IQR: 2.5-13.6) years, according to the researchers. Compared with a recurrence rate of around 30% in the general population, the researchers said they found this rate to be surprisingly low.
“This raises interesting questions about whether the underlying immunomodulatory treatment in lupus patients is the driving factor and how a similar concept can be applied to a selected group of non-SLE patients with recurrent pericarditis,” co-author Luigi Adamo, MD, PhD, director of cardiac immunology at Johns Hopkins University, told Healio.
According to the researchers, the likelihood of recurrence decreased with age. Patients aged older than 60 years demonstrated a rate ratio of 0.11 (95% CI, 0.04-0.32) vs. those aged 18 to 39 years, based on the multivariable analysis.
Meanwhile, factors that increased recurrence rates included:
- prednisone treatment (20 mg vs. 0 mg: RR: 1.99; 95% CI, 1.17-3.4);
- active SLE (SLEDAI 3 vs. 0: RR: 1.55; 95% CI, 1.21-2); and
- a shorter time since the initial episode (3-10 years vs. <1 year: RR: 0.32; 95% CI, 0.2-0.52).
The association with prednisone treatment was dose dependent, the researchers wrote. Patients taking 1 mg to 9 mg daily were least likely to have recurrent pericarditis (RR = 1.54; 95% CI, 0.85-2.79), and those on 20 mg or more per day were most likely (RR = 3.92; 95% CI, 2.31-6.63).
“Although a causal relationship cannot be established due to the observational nature of the study, the findings suggest that clinicians should be cautious when using oral prednisone to treat lupus-related pericarditis and consider steroid-sparing alternatives whenever possible,” Fava said. “Importantly, this association was independent of disease activity.”
According to Adamo, the findings highlight “the importance of personalizing treatment for lupus patients with pericarditis.”
“Although corticosteroids are often used to rapidly control lupus activity, they may not be the best option for managing pericarditis — and possibly other disease manifestations, as well,” he said. “Moving forward, we hope these findings encourage further research into fast-acting, steroid-sparing strategies that can improve long-term outcomes for these patients.”
Future research should also be devoted to the performance of new treatments for recurrent pericarditis in patients with lupus, Fava added.
“Treatment of recurrent pericarditis in the general population has been transformed by the interleukin-1 blockers,” he said. “There is minimal data on the use of these agents in patients with lupus.”
For more information:
Andrea Fava, MD, can be reached at afava1@jh.edu; X (Twitter): @andreafava.
Luigi Adamo, MD, PhD, can be reached at ladamo2@jhmi.edu; X (Twitter): @luigiadamomdphd.
Sources/Disclosures
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Disclosures:
This study was partly funded by grants from the National Heart, Lung and Blood Institute separately awarded to Adamo and Jana Lovell, MD, while the Hopkins Lupus Cohort is supported by a grant to Fava. Co-authors Daniel Goldman, PhD, MCS, and Michelle Petri, MD, MPH, report receiving grants through the Johns Hopkins University School of Medicine outside this study. Adamo reports receiving personal fees from Kiniksa Pharmaceuticals and Novo Nordisk, as well as being a co-founder of I-Cordis LLC outside this study.