Lupus and Pericarditis

Systemic lupus erythematosus (SLE), the most common form of lupus, is an autoimmune disease that attacks your body’s immune system. Lupus can affect a wide variety of organ systems and body parts including your skin, joints, and internal organs. When lupus attacks your heart it can cause pericarditis, inflammation of the thin sac surrounding the heart – what is known as the pericardium. 

Lupus pericarditis is the most common type of heart disease affecting those with lupus. The trigger, it seems, is antigen-antibody complexes produced during active lupus. These antigen-antibody complexes, also known as immune complexes, can cause inflammation within the pericardium.

While mild cases of pericarditis often improve on their own, and in less than a month, if you have lupus, it may take longer to heal. Since pericarditis doesn't directly affect the tissue in your heart, it's unlikely the condition will impair your heart’s functioning. However, chronic inflammation can scar the tissue in your heart, interfering with its ability to pump blood.

In addition to causing pericarditis, lupus can also cause myocarditis, endocarditis, and coronary artery disease. These conditions, however, are less common than pericarditis. 

If you have unexplained pericarditis and have not been diagnosed with lupus, your doctor may want to screen you for the condition. In many cases, what's causing pericarditis can be difficult to determine. For those who have not yet be diagnosed, pericarditis could be indicative of lupus.

The most common symptom of pericarditis is sharp, stabbing chest pain right behind the breastbone or on the left side of your chest. Pain often intensifies when lying flat or inhaling deeply. Sitting up and leaning forward often ease the pain.

Other signs and symptoms your physician will look for include:

• Shortness of breath
• Low-grade fever
• Fatigue or feeling sick
• Dry cough
• Abdominal or leg swelling

Beyond lupus, pericarditis can also be caused by a heart attack, viral infection, trauma, health problems such as kidney failure, and, in rare instances, certain medications.

In addition to taking your medical history and physical exam, to determine the cause of your pericarditis, and to confirm or rule out lupus as the culprit, your physician will conduct tests, including any number of those listed below:

• Blood tests 
• Electrocardiogram
• Chest X-ray
• Echocardiogram
• CT scan (computerized tomography)
• MRI (magnetic resonance imaging)

If you have lupus and pericarditis, your doctor will likely treat the inflammation in your heart with anti-inflammatory drugs. If these drugs don't help, you may need a brief course of a corticosteroid treatment instead.

In rare cases, surgery may be required. Surgery is typically reserved for people who have large or loculated pericardial effusions in association with the pericarditis. In these cases, pericardial drainage may be necessary. Drainage is rarely done and only necessary when the fluid is resulting in impaired cardiac function.