Prednisone Use Linked to Higher Risk of Pericarditis Recurrence in Lupus Patients: Study Finds

Pericarditis, or inflammation of the pericardium—the protective sac surrounding the heart—is a recognized manifestation of lupus. Although it typically responds well to treatment, a notable proportion of patients experience recurrence, which complicates disease management and affects overall quality of life. Despite its clinical relevance, the prevalence and contributing risk factors for recurrent pericarditis in individuals with systemic lupus erythematosus (SLE) had not been clearly defined.

To address this gap, Yoo Jin Kim from the Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, and colleagues investigated the frequency of pericarditis recurrence in patients with SLE and sought to identify the key factors associated with its occurrence.

For this purpose, the researchers conducted a retrospective analysis using data from a well-defined, single-center prospective cohort of patients with systemic lupus erythematosus (SLE), treated at a tertiary medical center and enrolled between 1988 and 2023. The study focused on patients from the Hopkins Lupus Cohort who had been diagnosed with pericarditis. Data analysis took place between April 2023 and May 2024. To assess recurrence, the team used the SELENA-SLEDAI criteria to define pericarditis and reviewed clinical details from all follow-up visits after the initial episode. Any pericarditis event occurring at least six weeks after the first recorded episode was considered recurrent.

Key Findings:

• Out of 2,931 patients in the Hopkins Lupus Cohort, 590 had experienced pericarditis. Among these, 43.6% were under the age of 30 at the time of their first episode, 90.5% were women, 51.4% were Black, and 42.9% were White.
• In 3.6% of cases (21 patients), the diagnosis was confirmed using ECG or imaging, with complete agreement between clinical findings and database records.
• Over a median follow-up of 6.7 years, covering a total of 5,277 person-years, 120 patients (20.3%) had recurrent pericarditis.
• The recurrence rate was 0.053 recurrences per person-year.
• Among those with recurrence, about half (50.8%) experienced only one episode, while 49.2% had two or more recurrences.
• Younger patients were more likely to have recurrences, with those aged 60 or older significantly less likely than those under 40 to experience recurrence.
• Prednisone use of 20 mg or more daily was linked to a higher recurrence risk compared to those not on the medication.
• Patients with active lupus (SLEDAI ≥3) had a greater chance of recurrence than those without active disease.
• The risk of recurrence was also higher within the first year after the initial episode, decreasing over time.

This study highlights that recurrent pericarditis in patients with systemic lupus erythematosus is more likely to occur within the first year of the initial episode, particularly among younger individuals, those with active disease, and those receiving oral prednisone therapy. A clear dose-dependent link between corticosteroid use and recurrence was observed, raising concerns about its role in managing pericarditis in this population.

"These findings emphasize the need to reconsider the routine use of oral corticosteroids for pericarditis in SLE and lay the groundwork for future research to identify safer and more effective treatment approaches for this common cardiac complication," the authors concluded.

Reference:

Kim YJ, Lovell J, Diab A, et al. Incidence and Factors Associated With Recurrent Pericarditis in Lupus. JAMA Netw Open. 2025;8(2): e2461610.doi:10.1001/jamanetworkopen.2024.61610