Recurrent Pericarditis in Lupus: Who’s Most at Risk?

TOPLINE:

Recurrent pericarditis occurred in one fifth of patients with systemic lupus erythematosus (SLE), with higher recurrence rates observed in younger patients and those receiving oral prednisone therapy. The risk for recurrence was greatest within the first year after initial diagnosis, particularly in patients with active disease.

METHODOLOGY:

• Researchers assessed the recurrence rate of pericarditis in this retrospective analysis of a diverse cohort of patients with confirmed SLE enrolled from 1988 to 2023.
• They included 590 patients with a history of pericarditis, of whom 451 experienced their first episode of pericarditis before cohort entry and 139 with their first episode during cohort participation. The cohort included 535 women, 303 Black patients, and 257 patients aged less than 30 years at the time of their first episode.
• Pericarditis was diagnosed with the Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SLEDAI), and its recurrence was defined as episodes occurring at least 6 weeks after the first recorded episode.
• Pericarditis was diagnosed with the Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SLEDAI), and its recurrence was defined as episodes occurring at least 6 weeks after the first recorded episode.

TAKEAWAY:

• During a median follow-up duration of 6.7 years, 20.3% of patients had recurrent pericarditis, with a recurrence rate of 0.053 episodes per person-year of follow-up; among these patients, 49.2% had multiple episodes.
• Active lupus (SLEDAI score ≥ 3) was associated with a significantly greater risk for recurrence (rate ratio, [RR], 2.34; 95% CI, 1.65-3.30), while older age was associated with decreased risk (50-59 years vs 18-39 years: RR, 0.25; 95% CI, 0.12-0.53).
• Recurrence was more likely to occur within the first year from onset, after which its likelihood reduced to almost half (1-3 years vs
• The use of oral prednisone showed a positive, dose-dependent association with recurrence (≥ 20 mg daily: RR, 3.92; 95% CI, 2.31-6.63).

IN PRACTICE:

“Overall, our findings suggest that specific subgroups of patients with pericarditis may benefit from close monitoring and early initiation of therapies proven to be effective for recurrent pericarditis, especially given that recurrence is more likely to occur within 1 year of the onset of pericarditis,” the authors wrote.

SOURCE:

This study was led by Yoo Jin Kim, MD, MS, Johns Hopkins University, Baltimore, Maryland. It was published online on February 25 in JAMA Network Open.

LIMITATIONS:

Most patients were diagnosed on the basis of symptomatic reports of pericardial chest pain, with only a small subset undergoing ECG or imaging studies for confirmation. The retrospective nature of the analysis may have led to misclassification of incessant pericarditis as recurrent pericarditis, though the authors noted this risk was minimized by frequent patient evaluations.

DISCLOSURES:

This study was supported by grants from the National Heart, Lung, and Blood Institute. One author received grants from Johns Hopkins University School of Medicine during the conduct of the study, and one disclosed receiving personal fees from pharmaceutical organizations and being a co-founder of I-Cordis LLC.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.