A review in The Lancet Rheumatology (1 October 2026) examines the European Society of Cardiology's 2025 guideline on myocarditis and pericarditis, which lists systemic autoimmune rheumatic disease among the causes, and asks how well it serves rheumatology patients.
The authors' answer is: not well. Heart involvement in these diseases is common and carries a poor prognosis, but it is usually subclinical and often atypical. Conventional biomarkers and imaging, including cardiac MRI, are less accurate against a background of chronic inflammation. Management mainly targets the underlying disease, which the generic cardiology pathways do not reflect.
This is expert opinion, not new data, and it does not change the guideline. Its practical point is that a normal troponin or a scan read in isolation may not settle the question in a patient with lupus, systemic sclerosis or myositis, and that these decisions are best made jointly with cardiology.
- Have a low threshold to look for myopericardial involvement in systemic autoimmune rheumatic disease.
- Interpret troponin, ECG and cardiac MRI in the light of background inflammation, not in isolation.
- Treat the underlying rheumatic disease as the main lever on cardiac involvement.
- Set up a joint rheumatology and cardiology route for these patients where possible.
Why it matters
Cardiac involvement is a leading cause of poor outcomes in these diseases and is easily overlooked when it is silent.
Don't overread it
This is a review and opinion piece; it does not change the ESC guideline.
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