Goswami RP, et al. - The objective of this study is to depict the incidence, risk factors and treatment of cardiac tamponade in a large cohort of Indian patients with systemic lupus erythematosus (SLE). This study suggests pleuritis, anti-nucleosome antibody and size of pericardial effusion predicted the development of tamponade. High dose immunosuppression (methylprednisolone and IV cyclophosphamide) alleviated the need for surgery in the majority.

Methods

• For this research, they designed a retrospective study.
• This study was conducted at the Department of Rheumatology, IPGMER, Kolkata, India from May 2014 to December 2016 on admitted patients with SLE.
• In this study, lupus-related serositis was diagnosed after excluding other causes, such as infection, malignancy or heart failure.

Results

• Of 409 patients with SLE, pericarditis was diagnosed in 25.4% (104/409) and cardiac tamponade in 5.9% (24/409).
• Tamponade was the presenting feature of SLE in 50% (12/24).
• Tamponade occurred in 77.8% (14/18) of large effusions and in 11.63% (10/86) of small-to-moderate effusions.
• The commonest autoantibody in serum and pericardial fluid was anti-nucleosme antibody. Large pericardial effusion (>20 mm) (Odd’s ratio (OR): 93.2, 95% confidence interval (CI): 11.1-782.5, p < 0.001) predicted tamponade.
• In the subset of patients with small-to-moderate sized pericardial effusion, tamponade was related to pleuritis (OR: 44.5, 95% CI: 1.6-1243, p = 0.025), anti-nucleosome antibody (OR: 42.9, 95% CI: 1.6-1176, p = 0.026) and size of pericardial effusion (OR: 1.36, 95% CI: 1.04-1.76, p = 0.025).
• Repeated pericardiocentesis was required in 3 patients and one needed surgical intervention.
• Immunosuppressives used were: prednisolone with monthly intravenous cyclophosphamide (in 33.33%) and intravenous methylprednisolone with monthly cyclophosphamide (in 50%).