Faculty Bibliography

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Inflammatory myocardial and pericardial syndromes (IMPS), including myocarditis, pericarditis, and overlapping myopericardial syndromes, constitute a heterogeneous group of immune-mediated cardiac disorders with clinical trajectories ranging from complete recovery to progressive heart failure and sudden death. This state-of-the-art review synthesizes current insights into immunopathogenesis, emphasizing the interplay among genetic susceptibility, environmental factors, and systemic inflammatory drivers, including rheumatological diseases. A pragmatic diagnostic framework is presented; it integrates targeted serological evaluation, genetic testing, multimodality imaging, and selective endomyocardial biopsy to enable precise etiologic classification. Therapeutic strategies are examined across the spectrum of disease severity, including guideline-directed medical therapy for heart failure, immunosuppression for autoimmune and fulminant phenotypes, and cytokine-directed biologics for recurrent pericarditis. Prognostic determinants, indications for advanced heart failure therapies, and emerging directions in precision immunology, molecular profiling, and AI-enabled risk stratification are discussed to guide future clinical and translational advances.

IMPORTANCE/UNASSIGNED:Psoriasis is a chronic immune-mediated disease associated with cardiovascular, metabolic, musculoskeletal, psychiatric, hepatic, kidney, and pulmonary comorbidities. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are approved by the US Food and Drug Administration for type 2 diabetes, obesity, cardiovascular risk reduction, chronic kidney disease, obstructive sleep apnea, and metabolic dysfunction-associated steatohepatitis-conditions common in psoriasis. Emerging evidence suggests GLP-1 RAs and dual glucose-dependent insulinotropic polypeptide/GLP-1 agonists may improve psoriatic skin disease, partly through immune modulation. If confirmed in larger randomized clinical trials, GLP-1-based therapies may offer an opportunity to address both cutaneous disease and cardiometabolic comorbidities. This primer from the US National Psoriasis Foundation Medical Board sought to provide an evidence-informed narrative synthesis and practical considerations to introduce dermatologists to GLP-1 RAs for psoriasis treatment. OBSERVATIONS/UNASSIGNED:GLP-1 RAs have been associated with reductions in Psoriasis Area and Severity Index (PASI) scores, particularly in patients with obesity or type 2 diabetes. Studies report relative PASI reductions ranging from approximately 40% to 80% with parallel quality-of-life gains, although most of these studies are small (7-48 patients), short term (≤6 months), and lack a control group. Semaglutide and liraglutide have been associated with reductions in C-reactive protein, interleukin-6, lipids, and visceral adiposity. In small, translational cohorts, PASI improvement has been correlated with reductions in superficial adiposity and dermal γδ T-cell density. GLP-1 RAs combine safely with methotrexate, cyclosporine, and biologics. Adverse effects are mainly transient gastrointestinal symptoms; pancreatitis and gallbladder events are rare. Early data show both metabolic and immunomodulatory benefits. CONCLUSIONS AND RELEVANCE/UNASSIGNED:This review found that GLP-1-based therapies target shared metabolic and inflammatory pathways in psoriasis. Current evidence supports consideration of adjunctive use in selected patients with metabolic comorbidities, although definitive conclusions await larger randomized clinical trials.

Pericarditis is the most frequent manifestation of pericardial disease and accounts for up to 5% of emergency department visits for chest pain. Although traditionally considered a benign and self-limited condition, it is a heterogeneous syndrome with a broad aetiological spectrum and potentially significant morbidity. While mortality is low, the burden of complications like recurrent disease, cardiac tamponade or constrictive pericarditis, and the frequent need for hospitalisation underscore its clinical relevance. The growing availability of multimodality imaging and the publication of updated international guidelines in 2025 have recently renewed attention to pericardial diseases, refining diagnostic criteria, risk stratification and therapeutic approaches. In high-income settings, idiopathic or presumed viral pericarditis remains the most common presentation. However, a substantial proportion of patients harbour alternative aetiologies that carry distinct prognostic implications and require tailored diagnostic and management strategies. In this review, we use the ABCDE mnemonic as a pragmatic framework to highlight five clinically important and often under-recognised forms of pericardial disease. Pericarditis associated with autoimmune and systemic inflammatory diseases is typically characterised by recurrent or refractory inflammatory courses and frequent extracardiac involvement. Bacterial pericarditis, although rare, represents a life-threatening condition requiring rapid aetiological identification and aggressive therapy. Cancer-related pericardial disease often presents with large pericardial effusions or cardiac tamponade and is associated with a poor prognosis largely determined by the underlying malignancy. Damage-related and drug-related pericarditis encompasses postcardiac injury syndromes and pharmacological toxicity. Finally, endocrine and metabolic disorders, including uraemia, hypothyroidism and infiltrative conditions such as amyloidosis, are associated with pericardial disease that manifests with atypical features and effusion. Early recognition of these entities is critical, as management extends beyond standard anti-inflammatory therapy and often requires correction of the underlying cause and close multidisciplinary collaboration. This ABCDE approach can aid clinicians in identifying these uncommon high-risk forms of pericarditis and optimising patient-centred care.

UNLABELLED:Systemic lupus erythematosus (SLE) is associated with increased cardiac morbidity and mortality and involves a range of cardiac pathologies. The most common of these is a simple pericardial effusion, though rarely this can be complicated by constrictive pericarditis. We present a case illustrating a rare SLE-mediated effusive-constrictive pericarditis. A 70-year-old female with a history of a prior stroke and coronary artery disease presented with 2 weeks of dyspnea, pleuritic chest pain, and fever. Her labs were notable for acute kidney injury with hematuria and proteinuria, elevated inflammatory markers, positive anti-nuclear antibody, low complement levels, and positive double-stranded DNA. CT scan of the chest showed circumferential pericardial effusion with echocardiogram and right heart catheterization confirming effusive-constrictive pericarditis. Clinically, she met diagnostic criteria for SLE and additionally underwent renal biopsy that confirmed SLE nephritis. The patient was started on colchicine, hydroxychloroquine, mycophenolate mofetil, and prednisone. A 3-month follow-up echocardiogram demonstrated resolution of the pericardial effusion and constrictive physiology. Effusive-constrictive pericarditis is a rare but important manifestation of pericardial disease in SLE. Treatment of the underlying SLE led to the resolution of the pericardial pathology. LEARNING OBJECTIVE/UNASSIGNED:Systemic lupus erythematosus (SLE) is a heterogeneous illness that causes significant morbidity and mortality across a variety of organ systems. Our aim is to educate clinicians on the spectrum of cardiac manifestations in SLE with a particular focus on pericardial disease. Using our case as a reference, we hope to highlight developments in diagnosis and management of pericardial disease in SLE.