Incidence and Factors Associated With Recurrent Pericarditis in Lupus

Pericarditis is the most common cardiac manifestation of systemic lupus erythematosus (SLE) and is known to recur among patients. However, the prevalence of and risk factors associated with recurrent pericarditis in patients with SLE were unknown.

To investigate the frequency of and risk factors associated with the recurrence of pericarditis in patients with SLE.

This cohort study was a retrospective analysis of a well-characterized, single-center prospective cohort of a diverse group patients with SLE treated at a tertiary medical center and enrolled between 1988 and 2023. Patients diagnosed with pericarditis among those enrolled in the Hopkins Lupus Cohort were included. Data were analyzed from April 2023 and May 2024.

Recurrence of pericarditis was assessed. The Safety of Estrogens in Systemic Lupus Erythematosus National Assessment revision of the SLE Disease Activity Index (SELENA-SLEDAI) was used to define pericarditis. Clinical information was examined for all follow-up encounters after the first episode of pericarditis. Episodes that occurred at least 6 weeks after the first recorded episode were defined as recurrent.

Of 2931 patients within the Hopkins Lupus Cohort, 590 patients had a history of pericarditis (257 patients aged <30 years at first episode [43.6%]; 535 women [90.5%]; 303 Black [51.4%] and 253 White [42.9%]). In 21 patients (3.6), the diagnosis of pericarditis was confirmed via electrocardiogram or dedicated imaging, with 100% concordance between clinical and database diagnoses. During a median (IQR) follow-up of 6.7 (2.5-13.6) years and a total of 5277 years of follow-up, 120 patients (20.3%) experienced recurrent pericarditis (recurrence rate = 0.053 recurrences; 95% CI, 0.047-0.059 recurrences per person-year of follow-up). Among patients with recurrence, most patients (61 individuals [50.8%]) experienced only 1 recurrence, whereas 59 patients (49.2%) had 2 or more recurrences. In multivariable analysis, factors associated with recurrence included younger age (≥60 vs <40 years: rate ratio [RR], 0.11; 95% CI, 0.04-0.32), treatment with prednisone (≥20 mg 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).

In this study, recurrence was more likely within 1 year of the onset of pericarditis and among younger patients, those with uncontrolled disease, and those receiving oral prednisone therapy, with a dose-dependent association. These findings may set the basis for future studies to define optimal treatment for recurrent pericarditis in patients with SLE and suggest that oral corticosteroids should be avoided when treating pericarditis in patients with SLE.