Recurrent Pericarditis in Lupus: What You Need to Know

At the Myocarditis Foundation, we focus on conditions that affect the heart, including pericarditis. Pericarditis is when the lining around the heart becomes inflamed, and it’s a problem that often affects people with lupus. Lupus is an autoimmune disease, meaning the body’s immune system mistakenly attacks its own tissues, and this can lead to heart issues like pericarditis.

A recent study from Journal of the American Medical Association (JAMA) looked at people with lupus who have had pericarditis, focusing on how often it comes back and what factors play a role in its recurrence.

Key Findings from the Study

The research focused on 590 lupus patients who had experienced at least one episode of pericarditis, which is an inflammation of the pericardium, the thin sac around the heart. Lupus patients are at higher risk for heart-related complications like pericarditis because lupus itself is an autoimmune disease. This means that the immune system, which normally fights infections, starts attacking healthy tissues—including the heart.

The study found that approximately 20% of patients with lupus had recurrent pericarditis, meaning their pericarditis returned after the initial episode. Most of these recurrences happened within the first year after the initial episode, making that period especially critical for monitoring and treatment.

Factors Linked to Recurrence

Several factors were linked to a higher risk of pericarditis returning in lupus patients:

1. Younger Age: Younger patients (especially those under 30) were more likely to experience recurrent pericarditis. In the study, patients aged 18-39 had the highest recurrence rate compared to older age groups.
2. Active Lupus Disease: The more active a patient’s lupus (measured by the severity of their symptoms), the higher the risk of recurrent pericarditis. Lupus activity often affects multiple organs and can make managing heart complications more challenging.
3. Prednisone Use: Interestingly, patients who were treated with prednisone, a common steroid used to reduce inflammation, were more likely to experience recurrence of pericarditis. In fact, the higher the dose of prednisone, the higher the risk. This is significant because steroids are often a go-to treatment for inflammation, but the study suggests they may have a negative impact on pericarditis outcomes. The findings raise questions about whether steroids should continue to be used to treat pericarditis in lupus patients.
4. Time Since First Episode: The study also found that the risk of recurrence dropped significantly after the first year. This means that patients are at the highest risk for recurrence within the first 12 months after their initial pericarditis diagnosis, so close monitoring during this time is important.

What the Study Means for Treatment

The findings of this study suggest that healthcare providers may need to rethink their treatment approaches for lupus patients who experience pericarditis. Currently, steroids like prednisone are commonly prescribed to reduce inflammation, but this study highlights the risks associated with high doses of prednisone for recurrent pericarditis.

The study recommends looking for alternative treatments that don’t involve high-dose steroids. For example, medications like colchicine (which is often used to treat gout) and nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to be effective in managing pericarditis, and they might be safer options for lupus patients. Additionally, newer treatments that target specific parts of the immune system, like interleukin-1 blockers, have shown promise in reducing inflammation and preventing recurrence in other types of pericarditis.

Why This Matters for the Myocarditis Foundation

While pericarditis and myocarditis are different conditions, both involve inflammation of the heart and can be dangerous if not properly managed. Research like this helps us understand the complexities of autoimmune diseases like lupus and how they can impact heart health. It also underscores the importance of finding treatments that are both safe and effective for people who have heart complications related to autoimmune diseases.

At the Myocarditis Foundation, we are committed to sharing the latest research and medical advancements to help patients and families make informed decisions about their health. This study’s findings provide important insights into managing pericarditis in lupus patients, and we will continue to monitor research developments in this area.

What Can Patients Do?

If you or a loved one has lupus and is experiencing pericarditis, here are some important takeaways from the study:

1. Stay Informed: Make sure you understand the risks and benefits of the treatments your doctor recommends. Ask about alternatives to high-dose steroids if you’re concerned about the risk of recurrence.
2. Monitor Your Symptoms: If you’ve had pericarditis, especially within the first year of diagnosis, stay in close contact with your doctor and keep an eye on any recurring symptoms, such as chest pain, shortness of breath, or fatigue.
3. Explore Other Treatment Options: Talk to your healthcare provider about other medications, such as colchicine or NSAIDs, which may be better suited for preventing recurrences of pericarditis.
4. Seek Support: Living with lupus and heart complications can be challenging, both physically and emotionally. It’s important to connect with support networks and resources, such as those available through the Myocarditis Foundation, to help you navigate these challenges.

We are here to support patients and families every step of the way, as we work together to promote heart health and raise awareness about these critical issue. You Can read the full study for yourself with the link below.

JAMA: Incidence and Factors Associated With Recurrent Pericarditis in Lupus