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A recent study involving more than 2,900 patients suggests that minimizing the use of corticosteroids may be the best approach when treating individuals with lupus pericarditis, a common heart complication associated with systemic lupus erythematosus (SLE). The study, conducted by Johns Hopkins Medicine cardiologists and rheumatologists, provides evidence that steroid treatment, while aimed at reducing inflammation and pain, also increases the likelihood of pericarditis recurrence.
Published in JAMA Network Open, the study affirms that corticosteroid use is a significant risk factor for recurring pericarditis—a condition that causes inflammation of the pericardium, the sac-like membrane that encases and protects the heart. According to the American Heart Association, pericarditis typically manifests as chest pain that worsens when lying flat and improves when leaning forward. Treatment options include colchicine—an anti-inflammatory medication designed to prevent recurrence—and corticosteroids.
Pericarditis affects between 15% and 30% of SLE patients, yet prior to this research, there was little data available on pericarditis recurrence in this specific population. “It is well known that in the general population, one-fifth of patients who experience pericarditis will have one or more recurrences. Surprisingly, even though pericarditis is the most common cardiac complication of lupus, there was limited information regarding its recurrence among lupus patients,” said Dr. Luigi Adamo, M.D., Ph.D., director of Cardiac Immunology at Johns Hopkins University and co-senior author of the study.
To address this knowledge gap, researchers analyzed data from the Hopkins Lupus Cohort, an ongoing study group that includes information on 2,931 patients diagnosed with SLE between 1988 and 2023. Within this cohort, 590 patients were also diagnosed with pericarditis. Researchers identified pericarditis cases using the Safety of Estrogens in Lupus Erythematosus National Assessment—SLE Disease Activity Index (SELENA-SLEDAI), a standardized tool for evaluating SLE clinical activity.
The findings revealed that 20% of lupus patients with pericarditis experienced recurrence, most frequently within the first year of onset. Younger patients and those with uncontrolled lupus were at greater risk. Notably, oral prednisone therapy—a commonly used treatment for lupus pericarditis—was associated with an increased likelihood of recurrence.
“The cardiology literature has already demonstrated that corticosteroids raise the risk of recurrent pericarditis in the general population. Despite this, steroids are often prescribed by rheumatologists to treat lupus pericarditis. Our findings highlight the importance of minimizing corticosteroid use in lupus patients and exploring alternative treatment strategies,” said Dr. Andrea Fava, M.D., a rheumatologist and co-senior author of the study.
Other contributors to the study include Johns Hopkins researchers Yoo Jin Kim, Jana Lovell, Daniel Goldman, and Michelle Petri.
Reference: Yoo Jin Kim et al, “Incidence and Factors Associated With Recurrent Pericarditis in Lupus,” JAMA Network Open (2025). DOI: 10.1001/jamanetworkopen.2024.61610
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Patients should consult their healthcare providers before making any changes to their treatment plans.
