Objective Pericarditis is a common and recurring manifestation of systemic lupus erythematosus (SLE). While guidelines for the management of SLE include the use of non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, and glucocorticoids, the evidence for various treatments in SLE is limited. Evidence for the usage of colchicine for pericarditis in patients with SLE exists primarily in case reports and case series. The purpose of this study was to investigate colchicine usage and rates of recurrent pericarditis among patients with SLE. Methods This retrospective cohort study included patients with SLE treated at a tertiary care center between 2015 and 2025. Patients were included if they presented to the hospital with pericarditis based on the 2025 European Society of Cardiology (ESC) Guidelines and had follow-up for at least 1 year. Based on the ESC guidelines, recurrent pericarditis was defined as new symptoms or disease activity after clinical remission and was captured within 1 year of the initial presentation. Results Of the 55 patients included in the study, 47.3% received colchicine, 52.7% received NSAIDs and 56.4% received glucocorticoids. Recurrent pericarditis occurred in 45.5% of patients. In univariate analyses, age less than 40 years at first presentation of pericarditis was significantly associated with recurrent pericarditis as was treatment with an initiation or increase of glucocorticoids. Treatment with colchicine trended toward reduced recurrence, but the result was not statistically significant. In multivariate logistic regression including age, treatment with colchicine, and treatment with glucocorticoids, only treatment with glucocorticoids was significantly associated with recurrent pericarditis (odds ratio 4.31; 95% confidence interval 1.12-16.55). Conclusions In this study, recurrent pericarditis was common among patients with SLE and was associated with treatment with glucocorticoids. Colchicine was associated with a trend toward decreased recurrence rates, but this was not statistically significant. Given high recurrence rates among patients treated with steroids, additional studies are needed on non-steroidal therapies for pericarditis in SLE, including further research on colchicine.
Background Systemic lupus erythematosus (SLE) is a complex autoimmune condition with a high level of morbidity, mortality and healthcare costs. In New Zealand prevalence of the condition has been increasing over time, although studies to date are based on national administrative datasets or hospital records. Objective We aimed to estimate the prevalence of SLE based on primary care medical records in New Zealand and to evaluate the differences in age, gender and ethnicity. Methods Potential SLE cases were identified through electronic primary care records from 1 January 2000 to 20 March 2024. All records were manually reviewed to identify the diagnosis based on 2019 European League Against Rheumatism/American College of Rheumatology classification criteria. Prevalence was based on definite and probable cases. Results Sixty-eight SLE cases were identified (55 definite, 6 probable, 7 possible) from a total practice population of 96,348. The crude prevalence of SLE estimated using primary care records was 63.3 per 100,000 people in 2024. The World Health Organization age-standardised prevalence was 52.9 per 100,000 people in 2024. SLE prevalence generally increased with advancing age. Women were five times more likely than men to have SLE (RR 5.36, 95% CI 2.63 – 10.93. Pacific people had the highest age-standardised prevalence of SLE (94.1), followed by Asian (58.7), European/Others (48.3) and Māori (42.9 per 100,000). Conclusion The use of primary care medical records builds on national studies based primarily on administrative databases. Prevalence of SLE is highest in the elderly (>85 years), females and Pacific people based on primary care data in New Zealand.
Background Lupus nephritis (LN) affects over 60% of patients with systemic lupus erythematosus and is a risk factor for progression to end stage kidney disease. Guidelines recommend high dose parenteral methylprednisolone “pulses” for induction, although intravenous pulse therapy has not been rigorously compared to oral therapy. In this observational study, we report the outcomes of 17 patients who initiated therapy for LN with high dose oral dexamethasone. Methods LN patients treated with oral dexamethasone between December 2021, and January 2025, were identified and baseline characteristics were recorded. Patients were assessed for a complete renal response (CRR, uPCR < 500, eGFR > 80%), satisfactory renal response (SRR, uPCR < 700, eGFR > 80%), or partial renal response (PRR, uPCR ≤ half of baseline uPCR, eGFR > 80%) at 1 year after receipt of dexamethasone. Responses were compared to outcomes in the BLISS-LN, AURORA and REGENCY trials. Results Seventeen patients with LN treated with induction dexamethasone were identified. The average age was 40 years old, and 15 patients were female. Six patients were of African ancestry, four Hispanic ethnicity, and three were White. Fourteen patients had proliferative LN. 47% of patients achieved a CRR, 59% obtained a SRR, and 53% obtained a PRR. Renal outcomes compared favorably to outcomes in the active arms of the BLISS-LN, AURORA 1, and REGENCY studies. Biomarkers including C3, C4, and dsDNA antibodies improved throughout the period. Proteinuria declined in 14 of 17 patients. Conclusion Patients with LN initially treated with oral dexamethasone in place of intravenous pulse methylprednisolone achieved responses similar to outcomes in recent LN trials. Dexamethasone is a promising potential oral option to initiate treatment for LN obviating need for parenteral therapy.
Introduction Systemic Lupus Erythematosus (SLE) and lupus nephritis (LN) carry substantial cardiorenal risks. Conventional immunosuppressive therapies primarily target inflammation but leave a burden of residual renal and metabolic damage. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) provide clear cardiorenal protection in general populations, but data specific to SLE remains limited. This systematic review and meta-analysis evaluated the efficacy and safety of SGLT2i in patients with SLE and LN. Methods Comprehensive searches across five electronic databases (PubMed, Cochrane CENTRAL, Web of Science, Embase, and Scopus) were conducted up to April 2026 to identify randomized controlled trials (RCTs) and observational studies assessing SGLT2i in adult SLE/LN patients. Random-effects meta-analyses were performed to synthesize cardiorenal and safety outcomes using R Software. Results Six studies published between 2024 and 2025 were included. Pooled data demonstrated that SGLT2i use was associated with a significant improvement in estimated glomerular filtration rate (eGFR) compared to controls (MD: 4.02; 95% CI: 1.39–6.65; I 2 = 60.1%). SGLT2i significantly reduced the risks of progression to end-stage kidney disease (RR: 0.37; 95% CI: 0.25–0.56; I 2 = 11.0%), heart failure development (RR: 0.65; 95% CI: 0.56–0.75; I 2 = 0.0%), incident lupus nephritis (RR: 0.58; 95% CI: 0.44–0.76; I 2 = 0.0%), and re-hospitalizations (RR: 0.67; 95% CI: 0.57–0.79; I 2 = 0.0%). Furthermore, a significant reduction in all-cause mortality was observed (RR: 0.55; 95% CI: 0.36–0.86; I 2 = 76.2%). SGLT2i treatment demonstrated an acceptable safety profile across the included cohorts. The certainty of evidence for these findings was rated as low to very low, and results remain vulnerable to residual confounding from variables such as disease activity, corticosteroid burden, and immunosuppressive regimen. Conclusion Preliminary exploratory evidence suggests potential associations between SGLT2 inhibitors and cardiorenal outcomes in lupus nephritis. Given the low certainty of evidence and vulnerability to residual confounding from disease-specific variables, these hypothesis-generating findings require confirmation in well-designed randomized controlled trials.
