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New research suggests the use of oral prednisone should be limited in patients with systemic lupus erythematosus with a history of recurrent pericarditis.

Pericarditis is the most common cardiac complication of systemic lupus erythematosus (SLE) with risk for recurrence. However, the prevalence and risk factors associated with recurrent pericarditis in patients with the autoimmune disease have not been characterized.

To address this knowledge gap, Yoo Jin Kim, MD, MS, and colleagues examined the frequency and risk factors contributing to the recurrence of pericarditis in patients enrolled in the Hopkins Lupus Cohort. The findings were reported in JAMA Network Open.

The Hopkins Lupus Cohort is a large ongoing study group that includes 2,931 patients diagnosed with SLE and treated at a tertiary medical center between 1998 and 2023. Pericarditis in the dataset was identified using the Safety of Estrogens in Systemic Lupus Erythematosus National Assessment revision of the SLE Disease Activity Index (SELENA-SLEDAI), a validated tool in the assessment of SLE clinical activity. Recurrence was defined as episodes occurring at least 6 weeks after the first episode.

Of the cohort, 590 patients had a history of pericarditis. The first episode of pericarditis occurred in 257 (43.6%) patients younger than 30 years, affecting 535 women (90.5%). In only a small group (n=21; 3.6%) was pericarditis confirmed via ECG or imaging.

The researchers found that 20.3% of patients experienced recurrent pericarditis during a median follow-up of 6.7 years. Among patients with recurrence, 50.8% experienced only 1 recurrence, and 49.2% experienced 2 or more recurrences.

In a multivariable analysis, factors significantly associated with recurrence included younger age (≥60 years vs <40 years: rate ratio [RR], 0.11; 95% CI, 0.04-0.32 ), high-dose prednisone treatment (≥20 vs 0 mg: RR, 1.99; 95% CI, 1.17-3.40), active SLE disease (SLEDAI ≥3 vs 0: RR, 1.55; 95% CI, 1.21-2.00), and time since initial episode (3-10 years vs <1 year: RR, 0.32; 95% CI, 0.20-0.52).

The researchers noted that oral prednisone use should be minimized, given the risk of disease recurrence. “Our data suggest that despite the common practice to use prednisone to treat SLE flares, the use of oral corticosteroids should be avoided for patients with a recent history of pericarditis,” they wrote.

“These findings expand our understanding of lupus pericarditis, underscore the need to reconsider using oral prednisone to treat SLE flares involving the pericardium, and identify the need for further investigation of treatments for lupus pericarditis,” said the researchers.