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SLE Pericarditis — EECC MCQ

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ModeratePericardial DiseaseSLE PericarditisEECC

A 48-year-old woman with systemic lupus erythematosus develops progressive breathlessness. Echocardiography shows thickened pericardium and a moderate pericardial effusion. She has no chest pain or friction rub. CRP is mildly elevated. CMR shows pericardial enhancement. What pericardial condition is most common in SLE?

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Correct answer: D — Pericardial involvement (effusion and/or pericarditis) — the most common cardiac manifestation of SLE, occurring in up to 50% of patients; treatment targets the underlying SLE with immunosuppression plus anti-inflammatory therapy for symptomatic pericarditis

Pericardial disease is the most common cardiac manifestation of SLE, affecting up to 25-50% of patients. It ranges from asymptomatic small effusions to symptomatic pericarditis with large effusions and rarely tamponade. Constrictive pericarditis is uncommon in SLE (more associated with TB, radiation, and post-surgical). The 2025 ESC Myocarditis/Pericarditis Guidelines recognise autoimmune pericarditis (including SLE, rheumatoid arthritis, systemic sclerosis) as a specific aetiological category requiring treatment of the underlying condition in addition to standard anti-inflammatory therapy. Immunosuppression (corticosteroids, hydroxychloroquine, and disease-modifying agents as indicated for SLE) forms the backbone of management. Colchicine may be added for recurrence prevention.

Reference: ESC (2025): Guidelines for Myocarditis and Pericarditis