Relevance of the 2025 ESC guidelines for the diagnosis and management of myocarditis and pericarditis for systemic autoimmune rheumatic diseases

The European Society of Cardiology (ESC) released new guidelines in 2025 for the management of myocarditis and pericarditis, which include systemic autoimmune rheumatic diseases as one of the potential aetiologies. Myopericardial involvement in systemic autoimmune rheumatic diseases is common and associated with poor outcomes; however, the unique pathophysiology of myopericardial involvement in systemic autoimmune rheumatic diseases poses specific challenges and limits the applicability of the generic diagnostic pathways proposed in the 2025 ESC guidelines to the systemic autoimmune rheumatic disease population. Myopericardial disease in patients with systemic autoimmune rheumatic disease is usually subclinical, often with atypical clinical presentation, and the accuracy of conventional biomarkers including advanced imaging, to detect myopericaridal disease is reduced in this population compared with the general population due to chronic inflamation. Management of myopericardial involvement in patients with systemic autoimmune rheumatic diseases primarily targets the underlying rheumatic disease; however, disease-specific guidance and multidisciplinary care pathways for the management of myopericardial involvement in patients with systemic autoimmune rheumatic diseases are urgently required and should be developed jointly by experts in both rheumatology and cardiology.