Corticosteroid use associated with higher risk of recurrence of lupus pericarditis

Corticosteroid use associated with higher risk of recurrence of lupus pericarditis

A new study of more than 2,900 patients provides evidence that it is probably best to use as little corticosteroid medicine as possible when treating people with lupus pericarditis, a common cardiac complication of the autoimmune disease systemic lupus erythematousus (SLE).

This study, funded by the National Institutes of Health (NIH) National Heart, Lung and Blood Institute (NHLBI) and led by Johns Hopkins Medicine cardiologists and rheumatologists who led the study, say their analysis of data confirms that steroid use is a risk factor for a reduction in heart inflammation and other painful symptoms that cause the holy influx of hexes to recover for the risk factor for the risk factor for the risk factor for patients with a risk factor for patients with a risk factor for patients with a potential patient who is a risk factor for the inflows of the Hakos, a risk factor. Membrane that covers and protects the heart.

The results of this study were added on February 25thJama Network Open

According to the American Heart Association, pericarditis is defined as inflammation of the pericardium, a sac-like structure with two thin layers of tissue that surround the heart to hold it in place and protect it. Pericarditis typically presents as chest pain that can be improved by lying flat and by leaning forward. This pain can last anywhere from a few days to several months. Treatment options for pericarditis include the use of colchicine—an anti-inflammatory drug that prevents pericarditis from recurring—and corticosteroids.

Pericarditis occurs in 15 to 30% of SLE patients, a chronic autoimmune disease that causes the body's immune system to attack its own tissues.

It is known that in the general population one fifth of patients with pericarditis experience one or more recurrences. Surprisingly, although pericarditis is the most common cardiac complication of lupus, we were unable to find information about the recurrence of pericarditis in this patient population. “

Dr. Luigi Adamo, MD, PhD, director of cardiac immunology at Johns Hopkins University and co-senior author of this study

Researchers set out to address this knowledge gap and examine the risk factors that contribute to recurrence.

For the new analysis, researchers used data collected in the Hopkins Lupus Cohort, a large ongoing study group that includes information on 2,931 patients diagnosed with SLE between 1988 and 2023, and the researchers focused on data from 590 patients also diagnosed with pericarditis. Pericarditis in the dataset was identified using the Safety of Estrogens in Lupus Erythematosus National Assessment-SLEIS Activity Index (SELENA-SLEDAI), a standard tool for assessing clinical SLE activity.

The study results showed that 20% of patients with lupus who experienced pericarditis had a recurrence. Recurrent pericarditis was most common in patients in the first year of emericarditis onset, with recurrence decreasing in subsequent years. Younger patients and patients with uncontrolled disease had a higher risk of recurrence. It was found that oral prednisone therapy, a tool commonly used to treat pericarditis in patients with autoimmune diseases, was associated with a higher likelihood of pericarditis recurrence in patients with SLE.

"The cardiology literature has shown that the use of corticosteroids increases the risk of recurrent pericarditis in the general population. Nevertheless, steroids are very commonly used by rheumatologists to treat lupus pericarditis. Therefore, the results of this study underscore the importance of minimizing oral corticoster use in patients with lupus and suggest alternative strategies," said Andrea Fava, MD, a rheumatologist who specializes in the care of patients with lupus and co-senior author of the study.

Other Johns Hopkins researchers who contributed to the study include Yoo Jin Kim, Jana Lovell, Daniel Goldman and Michelle Petri.

This study was supported in part by NHLBI grants 5K08HLO145108-03 and 1R01HL160716-01 and NHLBI grant T32-HL007227. The Hopkins Lupus cohort is supported by R01DK134625.

Sources: