TOPLINE:

In patients with systemic lupus erythematosus (SLE) with serositis episodes, nearly half experienced relapses, with no difference in the response rate between corticosteroid-based and corticosteroid-free anti-inflammatory therapies. Conventional immunosuppressants were not associated with a reduced risk for serositis relapse, whereas belimumab was associated with a lower risk.

METHODOLOGY:

• Researchers conducted a multicentre, real-world, retrospective observational study to assess the efficacy of anti-inflammatory and immunosuppressive therapies in SLE-related serositis.
• They included 100 adult patients with SLE (mean age at diagnosis, 32.9 years; 80% women) who had documented pericarditis or pleuritis between January 2000 and October 2025 based on clinical and/or imaging criteria.
• The main endpoints were the efficacy of anti-inflammatory treatment on serositis at the first evaluation visit after the index episode and the time to serositis relapse, defined as recurrence at least 3 months after the index flare that required treatment intensification.
• Overall, 180 events of documented serositis, including 161 cases of pericarditis, 51 of pleuritis, and 32 involving both conditions, were recorded. The mean follow-up duration was 91 months.

TAKEAWAY:

• A favourable response was noted for the initial anti-inflammatory therapy in 87.1% (108/124 events) of cases with available data on treatment response, with no significant difference in response rates between corticosteroid-based and corticosteroid-free regimens (including aspirin and colchicine).
• Nearly half of the patients (46%) experienced multiple events of serositis relapse during follow-up, with a median time to first relapse of 0.83 years. Relapse rates were similar between patients who initially received corticosteroids and those who received corticosteroid-free therapies.
• Conventional immunosuppressants, such as methotrexate, azathioprine, and mycophenolate mofetil, were not associated with a reduced risk for serositis relapse.
• Belimumab was associated with a lower risk for serositis relapse (hazard ratio [HR], 0.34; 95% CI, 0.14-0.84), with similar findings observed in the pericarditis-only subgroup (HR, 0.22; 95% CI, 0.06-0.82).

IN PRACTICE:

"While further prospective studies are needed, our data support considering belimumab as a therapeutic option in patients with relapsing serositis," the authors wrote.

SOURCE:

This study was led by Elodie Fels, National Reference Center for Systemic Autoimmune Diseases, Strasbourg University Hospital in Strasbourg, France. It was published online on May 13, 2026, in RMD Open.

LIMITATIONS:

The retrospective design resulted in missing data. Incomplete information on treatment adherence for some episodes and on corticosteroid tapering may have introduced residual confounding. The later introduction of biologics and their increasing use over time may have led to risks for calendar-time and time-dependent confounding.

DISCLOSURES:

No specific funding was declared for the study. Three authors reported receiving consulting fees from AstraZeneca, GSK, Novartis, and other companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.