Patients with systemic lupus erythematosus treated with at least 20 mg of prednisone daily had an increased risk of recurrent pericarditis, with univariate analysis showing more than a threefold increase and multivariable analysis showing nearly a twofold increase, according to a recent study.
Investigators, led by Yoo Jin Kim, MD, MS, of the Department of Medicine at the School of Medicine at Johns Hopkins University, conducted a retrospective cohort study to evaluate the incidence and risk factors of recurrent pericarditis in patients with systemic lupus erythematosus (SLE). In the study, published in JAMA Network Open, the investigators analyzed data from the Hopkins Lupus Cohort, a well-characterized, single-center prospective cohort that enrolled patients between 1988 and 2023. The analysis included 590 patients with a history of pericarditis, with recurrence defined as an episode occurring at least 6 weeks following the initial diagnosis. Follow-up data were collected through May 2024, with a median follow-up duration of 6.7 years.
Among the study population, 20.3% (n = 120) of them experienced recurrent pericarditis, yielding a recurrence rate of 0.053 per person-year (95% confidence interval [CI] = 0.047–0.059). Most patients with recurrence (50.8%) had just one additional episode, whereas 49.2% of them had two or more recurrences. Younger age was a significant predictor of recurrence, with patients aged 60 years or older having a markedly lower risk compared with those younger than 40 years (rate ratio [RR] = 0.11, 95% CI = 0.04–0.32).
Active SLE disease, as measured by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), was also associated with increased recurrence risk. Patients with a SLEDAI score of 3 or higher had a 55% higher likelihood of recurrence compared with those without active disease (RR = 1.55, 95% CI = 1.21–2.00). Younger patients, those with active SLE, and those treated with prednisone had an increased risk of recurrent pericarditis, with prednisone showing a dose-dependent association. Prednisone doses of at least 20 mg daily were associated with over a threefold increase in recurrence risk in univariate analysis (RR = 3.92, 95% CI = 2.31–6.63), while multivariable analysis showed nearly a twofold increase (RR = 1.99, 95% CI = 1.17–3.40), indicating a strong dose-dependent effect. Although prednisone is commonly used to manage SLE flares, the study suggested that its use may increase the risk of recurrent pericarditis.
The risk of recurrence was highest within the first year following the initial pericarditis episode and declined over time (3 to 10 years vs < 1 year: RR = 0.32, 95% CI = 0.20–0.52). Other factors, including race, sex, kidney involvement, and pulmonary hypertension, were not independently associated with recurrence after adjusting for disease activity and medication use.
The findings indicated that younger patients with active SLE and those treated with prednisone had the highest risk for recurrent pericarditis. The investigators reported an association between corticosteroid use and recurrence, suggesting the need for further investigation into optimal treatment strategies.
Full disclosures can be found in the published study.