Incidence and Predictors of Recurrent Pericarditis in Systemic Lupus Erythematosus

IMPORTANCE Pericarditis is the most common cardiac manifestation of Systemic Lupus Erythematosus (SLE) and known to recur among patients. Yet, the prevalence and risk factors of recurrent pericarditis in SLE patients are unknown. OBJECTIVE Determine the frequency and risk factors for the recurrence of pericarditis in patients with SLE. DESIGN Retrospective analysis of a well-characterized, prospective cohort of SLE patients enrolled between 1988 and 2023. SETTING A single-center cohort study of a diverse group of SLE patients treated at a tertiary medical center. PARTICIPANTS Patients diagnosed with pericarditis (n=590) among those enrolled in the Hopkins Lupus Cohort (n=2931). MAIN OUTCOME Re-occurrence of pericarditis. The SELENA revision of the SLE Disease Activity Index (SLEDAI) was used to define pericarditis. Clinical information was examined for all follow-up encounters after the first episode of pericarditis. Pericarditis that occurred at least six weeks after the first recorded episode was defined as “Recurrent”. RESULTS Of 2931 patients within the cohort, 590 had a history of pericarditis. In 3.4% of patients, the diagnosis of pericarditis was confirmed via electrocardiogram (EKG) or dedicated imaging, with 100% concordance between clinical and data-based diagnoses. During a median follow-up of 7 years (IQR: 3 – 14), 20% (n=120) of patients experienced recurrent pericarditis (recurrence rate ≈ 0.05 per person-year of follow-up). Most patients (51%) experienced only one recurrence, whereas 49% had ≥2 recurrences. In multivariate analysis, predictors of recurrence included younger age (≥60 years vs. <40, RR 0.11 (0.04, 0.32), P <.001), treatment with prednisone (≥20 mg vs. 0, RR 1.99 (1.17, 3.40), P = 0.012), active SLE disease (SLEDAI ≥3 vs. 0, RR 1.55 (1.21, 2.00), P <.001), and time since initial episode (3-10 years vs. <1, RR 0.32 (0.20, 0.52), P <.001). CONCLUSION AND RELEVANCE Recurrence is more likely to occur within one year of the onset of pericarditis, and younger patients and those with uncontrolled disease are at greater risk of recurrence. As in the general population, oral prednisone therapy is associated with a higher chance of recurrence in SLE patients, with a dose-dependent effect. These findings set the basis for future studies to define optimal treatment for recurrent pericarditis in SLE patients and suggest that oral corticosteroids should be avoided when treating pericarditis.