Abstract
Background:
Corticosteroids are widely used in pericarditis despite guideline recommendations reserving them for select indications. Observational studies have reported inconsistent associations between corticosteroid use and pericarditis recurrence, and optimal dosing and tapering strategies remain unclear. We conducted a systematic review of oral corticosteroids for acute or recurrent pericarditis to characterize patterns of treatment and evaluate the association between corticosteroids and pericarditis recurrence across different disease contexts.
Methods:
MEDLINE, Embase, CENTRAL, and Scopus were searched from inception to November 26, 2025. Studies enrolling adults with acute or recurrent pericarditis treated with oral corticosteroids were included. Randomized trials, cohort studies, and case–control studies reporting clinical outcomes were eligible. Risk of bias was assessed using the Newcastle–Ottawa Scale. Data were synthesized descriptively due to anticipated clinical and methodological heterogeneity.
Results:
Ten studies (2 prospective and 8 retrospective) including 2632 patients (800 corticosteroid treated) met inclusion criteria. Prednisone was most frequently studied, with heterogeneous dosing (0.25–1.0 mg/kg/d) and nonstandardized tapering strategies. Follow-up ranged from 1 to 6.7 years, and overall risk of bias was moderate with limited adjustment for confounding. Findings on recurrence were inconsistent in acute idiopathic and postprocedure pericarditis, while most studies in recurrent pericarditis reported higher recurrence with corticosteroid exposure.
Conclusions:
Evidence evaluating oral corticosteroids in pericarditis is limited by heterogeneity, confounding, and inconsistent reporting of treatment strategies. Observational data show variable associations with recurrence across clinical contexts. High-quality randomized trials stratified by pericarditis etiology and acuity are needed to define the optimal use of corticosteroids in pericarditis.