Colchicine usage and recurrent pericarditis in patients with systemic lupus erythematosus

Objective Pericarditis is a common and recurring manifestation of systemic lupus erythematosus (SLE). While guidelines for the management of SLE include the use of non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, and glucocorticoids, the evidence for various treatments in SLE is limited. Evidence for the usage of colchicine for pericarditis in patients with SLE exists primarily in case reports and case series. The purpose of this study was to investigate colchicine usage and rates of recurrent pericarditis among patients with SLE. Methods This retrospective cohort study included patients with SLE treated at a tertiary care center between 2015 and 2025. Patients were included if they presented to the hospital with pericarditis based on the 2025 European Society of Cardiology (ESC) Guidelines and had follow-up for at least 1 year. Based on the ESC guidelines, recurrent pericarditis was defined as new symptoms or disease activity after clinical remission and was captured within 1 year of the initial presentation. Results Of the 55 patients included in the study, 47.3% received colchicine, 52.7% received NSAIDs and 56.4% received glucocorticoids. Recurrent pericarditis occurred in 45.5% of patients. In univariate analyses, age less than 40 years at first presentation of pericarditis was significantly associated with recurrent pericarditis as was treatment with an initiation or increase of glucocorticoids. Treatment with colchicine trended toward reduced recurrence, but the result was not statistically significant. In multivariate logistic regression including age, treatment with colchicine, and treatment with glucocorticoids, only treatment with glucocorticoids was significantly associated with recurrent pericarditis (odds ratio 4.31; 95% confidence interval 1.12-16.55). Conclusions In this study, recurrent pericarditis was common among patients with SLE and was associated with treatment with glucocorticoids. Colchicine was associated with a trend toward decreased recurrence rates, but this was not statistically significant. Given high recurrence rates among patients treated with steroids, additional studies are needed on non-steroidal therapies for pericarditis in SLE, including further research on colchicine.