How do you approach DMARD therapy in a patient with lupus and recurrent pericarditis?

Both asymptomatic pericardial effusions and symptomatic pericarditis are common in systemic lupus erythematosus (SLE) patients. I will limit my answer to symptomatic pericarditis per the question.

The first thing to be sure of is that the symptoms are truly due to pericarditis. The full differential diagnosis of pleuritic chest pain needs to be considered in patients with recurrent symptoms, especially if they are already on immunomodulatory therapy. It can be a mistake to automatically ascribe t...