Pericarditis in Systemic Lupus Erythematosus: A Comprehensive Review of Pathogenesis, Diagnosis, and Management

Pericarditis is the most common cardiovascular manifestation of systemic lupus erythematosus and affects a substantial proportion of patients during the course of the disease. Although it is often mild and self-limiting, lupus-associated pericarditis can result in substantial morbidity due to recurrent episodes and potentially life-threatening complications, including cardiac tamponade and constrictive pericarditis. Recent advances have expanded our understanding of its immunopathogenesis, highlighting the interplay between immune complex deposition, complement activation, type I interferon signaling, and dysregulated cell death pathways. Diagnostic evaluation relies on clinical assessment supported by electrocardiography and transthoracic echocardiography, while cardiac MRI has emerged as a valuable modality for detecting active inflammation, characterizing pericardial tissue involvement, and identifying constrictive physiology. In contrast to idiopathic pericarditis, management strategies should address both pericardial inflammation and the underlying autoimmune disease activity. Colchicine has become a cornerstone of therapy owing to its effectiveness in symptom control and recurrence prevention, whereas glucocorticoids and immunosuppressive agents remain essential for selected patients with active systemic disease. Emerging targeted therapies, including anifrolumab, belimumab, and IL-1 inhibitors, offer promising alternatives for refractory or recurrent cases, although disease-specific evidence remains limited. This review provides a comprehensive overview of the current understanding of lupus-associated pericarditis, encompassing its pathophysiology, clinical manifestations, diagnostic approach, and therapeutic management, while highlighting recent advances and key areas for future research.