Firstly, I have not had a truly refractory lupus pericarditis patient in a very long time. This would mean not responding to, or having intolerances to, antimalarials, MTX, mycophenolate, azathioprine, tacrolimus, IVIG, steroids, colchicine, NSAIDs, rituximab, belimumab, IVIG, and now (thank goodnes...

I would. There is no data that I am aware of, but I would. I explain why below. Patients with autoimmune diseases were excluded from the clinical trial that led to the approval of Riloancept and this class of patients is also excluded from the recurrent pericarditis registry sponsored by Kiniksa ph...

In my opinion, a better first step (beyond colchicine) to use Il1 pathway inhibition for refractory lupus pericarditis is a trial of Anakinra. This compound has been effective against idiopathic pericarditis in a good RCT. Its shorter half-life and lower initial cost than rilonacept make a short ini...

We just need to be aware that the pathophysiology of idiopathic recurrent pericarditis is different than of pericarditis secondary to an autoimmune process such as lupus as it is mediated by the adaptive immune system and Type 1 Interferon. Since with the former is driven by an ongoing cycle of IL-1...

I agree. I would use IL-1 inhibitors in cases where all other conventional immune suppressives or biologics are not helpful in controlling the disease and allow for steroid tapering.