The 2025 ESC guidelines on myocarditis and pericarditis list systemic autoimmune rheumatic diseases as a cause. A Lancet Rheumatology review by rheumatologists and cardiologists argues that the generic diagnostic pathways apply poorly to these patients.
Myopericardial involvement in rheumatic disease is common and linked to poor outcomes, yet is usually subclinical or atypical. Chronic inflammation reduces the accuracy of standard markers and even advanced imaging. Treatment mainly targets the underlying rheumatic disease. The authors call for joint rheumatology–cardiology pathways.
Until those exist, the practical point is a low threshold for cardiac assessment in patients with lupus, systemic sclerosis, myositis and vasculitis who develop unexplained breathlessness, chest pain or arrhythmia.
- Consider myopericardial involvement in rheumatic patients with unexplained breathlessness or arrhythmia.
- Interpret troponin and imaging cautiously against a background of chronic inflammation.
- Involve cardiology early when cardiac involvement is suspected.
- Treat the underlying rheumatic disease as the main lever for cardiac inflammation.
Why it matters
Standard pathways may miss cardiac disease in exactly the patients most at risk.
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