AB0521 PERICARDITIS IN SYSTEMIC LUPUS ERYTHEMATOSUS: CHARACTERISTICS, MANAGEMENT, EVOLUTION AND PREDICTIVE FACTORS FOR RELAPSE. A MONOCENTRIC RETROSPECTIVE STUDY.

Abstract

BackgroundPericarditis is frequent in Systemic Lupus Erythematosus (SLE) and usually benign. Dedicated studies are scarce. However, recurrences can lead to repeated steroid prescriptions and further immunosuppression. The best management, including the potential benefit of colchicine, remains to be determined.ObjectivesThe aim of this study was to describe management, evolution over time and risk factor for relapse in SLE pericarditis in our University Hospital Center.MethodsCases were retrospectively collected among hospital discharge data (coding code “SLE” and “pericarditis”), from January 1997 to December 2019. All SLE cases met the ACR/EULAR 2019 classification criteria. Pericarditis cases met ESC 2015 diagnosis criteria. Patients with conditions other than lupus known to cause pericarditis were excluded as well as patients with myocarditis. A minimal follow-up of one year after pericarditis diagnosis was mandatory. Relapse- free survival was described using an actuarial survival model.ResultsAmong 103 patients identified in the database, 29 patients (women: n=25, mean age 30 +/- 13 years) were included. Median follow-up was 7 years [range: 1-22].Description of first episodes: 31% (n= 9) were inaugural of SLE; otherwise, median time elapsed since SLE diagnosis was 65 months [1.7-400]. Fifty-five percent (n=16) of first episodes occurred during a multi-systemic lupus flare. Median SLEDAI-2K was 9 [range: 4-30|. Clinical symptoms and signs were typical chest pain (93%, n=27), dyspnea (55%, n=16); pericardial rub (31%, n=9), fever (38%, n=11). EKG was abnormal in 59% of the cases (n= 17). When present, 79% of effusions (n=17/22) were circumferential, 82% (n= 18/22) were mild to moderate (<20mm), and 25% (n=7) were dry pericarditis. Two Cardiovascular Magnetic Resonance imaging were performed and were pathological.Biological data showed always high CRP levels (65mg [range: 7-460]), high-titer anti-DNA (79%, n=19) but few patients had low complement levels (C3 21% (n=4/19), C4 26%(n=5/19)).Prescribed drugs were non-steroidal anti-inflammatory drugs/acetylsalicylic acid (NSAIDs/ASA) (41%, n=12), corticosteroids (66%, n=19; mean daily prednisone dose: 57.2mg +/- 13.9), colchicine 0.5 to 1mg/day (41%; n=12). There was a significant difference in SLEDAI-2K values at pericarditis onset between those treated with NSAIDs/ASA (7.5, [range: 0-16]) and those not (12, [range: 4-30]), (p<0.05). Only 41% (n=5) of colchicine prescriptions lasted at least 3 months; they were associated with a lower SLEDAI-2K at pericarditis onset compared to pericarditis not or insufficiently treated with colchicine (respectively, 7[range: 4-9] and 11[range: 4-30], p=0.04). Immunosuppressive drugs were prescribed in 17% (n=5) of the patients, always due to extra-pericardial involvements.Recurrences were frequent (55%, 16 patients out of 29) and multiple (1 to 6, average 3 ± 1.26). Short and long-term relapse-free survival tended to be better in patients exposed to at least 3 months of colchicine (100% vs 75% at 1 year, p=0.09) (Figure 1). There was no statistical difference (p=0.25) in terms of short-term relapse-free survival in patients treated with NDAIDs/ASA compared to those who were not. Corticosteroid prescription and previous antimalarial treatment were not associated with a poorer or better outcome during the year following remission (p=0.78). No patient has progressed to constriction.Figure 1.Relapse-free survival at 12 months according to colchicine prescriptionConclusionOur conclusions are limited due to the small number of patients and lack of multivariate analysis.Further studies are necessary to confirm the potential benefit of colchicine to prevent incessant pericarditis or relapses in this population.References[1]Kruzliak P, et al. Acta Cardiol 2013;68:629–33.Disclosure of InterestsNone declared