From the Guidelines
The initial management of pericarditis in patients with Systemic Lupus Erythematosus (SLE) typically involves nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line therapy, such as ibuprofen (600-800 mg three times daily) or indomethacin (25-50 mg three times daily) for 1-2 weeks, followed by gradual tapering, as recommended by the 2015 ESC guidelines 1.
Key Considerations
- The treatment approach should target both the inflammatory process of pericarditis and the underlying autoimmune activity of SLE.
- Colchicine (0.5-0.6 mg twice daily) may be added to prevent recurrence and should be continued for at least 3-6 months, as supported by the 2015 ESC guidelines 1.
- In cases of severe or refractory pericarditis, immunosuppressive agents like azathioprine, mycophenolate mofetil, or cyclophosphamide may be necessary.
- Hydroxychloroquine (200-400 mg daily) should be continued or initiated as part of the overall SLE management strategy.
- Patients should be monitored for signs of cardiac tamponade, which requires immediate pericardiocentesis.
Treatment Recommendations
- Aspirin or NSAIDs are recommended as first-line therapy for acute pericarditis, with colchicine added as an adjunct to improve response and prevent recurrences 1.
- Corticosteroids should be considered as a second option in patients with contraindications and failure of aspirin or NSAIDs, but with caution due to the risk of promoting chronic evolution of the disease and drug dependence 1.
- The choice of anti-inflammatory drug should be based on patient history, concomitant diseases, and physician expertise.
Monitoring and Follow-up
- Patients should be monitored for signs of cardiac tamponade, which requires immediate pericardiocentesis.
- CRP levels should be used to guide treatment duration and assess response to therapy, as recommended by the 2015 ESC guidelines 1.
- Athletes should be restricted from competitive sports for at least 3 months after the initial onset of the attack, or until symptoms have resolved and diagnostic tests have been normalized 1.
From the FDA Drug Label
During an exacerbation or as maintenance therapy in selected cases of: systemic lupus erythematosus Rheumatic Disorders As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation)
The initial management for pericarditis in patients with Systemic Lupus Erythematosus (SLE) may involve adjunctive therapy with prednisone for short-term administration to tide the patient over an acute episode or exacerbation.
- The use of prednisone is supported for rheumatic disorders and systemic lupus erythematosus.
- Key points:
- Prednisone may be used as adjunctive therapy for short-term administration.
- Systemic lupus erythematosus is listed as a condition for which prednisone may be used during an exacerbation or as maintenance therapy. 2
From the Research
Initial Management for Pericarditis in SLE
The initial management for pericarditis in patients with Systemic Lupus Erythematosus (SLE) involves several treatment options, including:
- Colchicine: a study published in 2015 3 found that colchicine may be safe and effective in treating SLE pericarditis and can be used as a steroids-sparing agent.
- Corticosteroids: while corticosteroids are usually very effective in treating pericarditis, colchicine may avoid the use or increase in dosage of steroids 3.
- Rilonacept: a case series published in 2024 4 found that rilonacept, an interleukin-1 receptor antagonist, led to complete or partial resolution of pericardial symptoms in patients with refractory lupus pericarditis.
- Immunosuppressants: in some cases, immunosuppressants such as cyclophosphamide or mycophenolate mofetil may be necessary to treat pericarditis in SLE patients 5, 6.
Treatment Goals
The goals of treatment for pericarditis in SLE patients include:
- Resolving pericardial symptoms
- Preventing relapse
- Avoiding or minimizing the use of steroids
- Treating any underlying SLE activity
Important Considerations
It is essential to note that pericarditis in SLE patients can be a manifestation of active disease, and treatment should be tailored to the individual patient's needs. Additionally, infectious causes of pericarditis should be excluded before initiating treatment 5.