Which condition is more likely to cause pericarditis, Gastroesophageal Reflux Disease (GERD) or Systemic Lupus Erythematosus (SLE)?

Systemic Lupus Erythematosus (SLE) Causes Pericarditis, Not GERD

Systemic Lupus Erythematosus (SLE) is a well-established cause of pericarditis, while Gastroesophageal Reflux Disease (GERD) is not associated with pericarditis. According to the European Society of Cardiology guidelines, pericardial involvement is common in SLE and is recognized as one of the most frequent cardiac manifestations of the disease 1.

Pericarditis in SLE

Epidemiology and Presentation

• Pericarditis is the most common cardiac manifestation in SLE patients 2, 3
• Occurs in up to 50% of SLE patients during the course of their disease 4
• Can be the initial presenting symptom of SLE in approximately 1% of cases 4
• In a recent cohort study of 2931 lupus patients, 590 (20%) had a history of pericarditis 5
• Recurrence rate is significant - 20.3% of SLE patients with pericarditis experience recurrence 5

Risk Factors for Pericarditis in SLE

The 2025 JAMA Network Open study identified several risk factors associated with recurrent pericarditis in SLE patients 5:

• Younger age (patients under 40 years had higher risk)
• Active SLE disease (SLEDAI ≥3)
• Higher doses of prednisone (≥20 mg)
• Recent onset (within 1 year of initial episode)

Pathophysiology

Pericardial involvement in SLE is primarily immune-mediated, with inflammation triggered by autoimmune mechanisms. The ESC guidelines specifically list SLE as a common autoimmune cause of pericarditis 1.

Treatment Considerations for SLE-Related Pericarditis

The GLADEL-PANLAR guidelines for SLE treatment note that 1:

• Standard of care plus colchicine is associated with significant benefits in decreasing pericarditis recurrence rates
• Belimumab likely has little to no effect on pericarditis-related symptom improvement

For recurrent pericarditis in SLE patients, evidence suggests that:

• Oral corticosteroids should be used cautiously as they may actually increase recurrence risk 5
• Colchicine appears to be beneficial for preventing recurrences 1, 4

GERD and Pericarditis

There is no evidence in the medical literature supporting GERD as a cause of pericarditis. The European Society of Cardiology guidelines on pericardial diseases do not list GERD among the etiologies of pericarditis 1. The comprehensive list of causes includes infectious, autoimmune, neoplastic, metabolic, traumatic and iatrogenic factors, but not GERD.

Clinical Implications

When evaluating a patient with pericarditis:

1. Consider SLE in the differential diagnosis, especially in:

   • Young patients
   • Women (90.5% of SLE pericarditis patients are female) 5
   • Patients with other symptoms suggestive of autoimmune disease

2. Look for other manifestations of SLE:

   • Joint pain and swelling
   • Skin rashes (malar rash, discoid lesions)
   • Renal involvement
   • Hematologic abnormalities

3. Diagnostic workup should include:

   • Antinuclear antibodies (ANA)
   • Anti-double stranded DNA antibodies
   • Complement levels
   • Inflammatory markers (ESR, CRP)
   • Echocardiography to assess for pericardial effusion

4. Treatment should target both the pericarditis and the underlying SLE

Conclusion

When considering the etiology of pericarditis, SLE is a well-established cause that should be on the differential diagnosis, while GERD is not associated with pericarditis. Clinicians should maintain a high index of suspicion for SLE in patients presenting with pericarditis, especially young women, and initiate appropriate diagnostic testing and treatment.