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Recurrent pericarditis: an update on diagnosis and management
Alessandra Vecchiè1, Megan Dell2, James Mbualungu3
1Division of Cardiology, Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA - alessandra.vecchie@vcuhealth.org.
Panminerva Medica
|February 23, 2021
Summary
Recurrent pericarditis, an inflammatory heart condition, often stems from immune issues and improper treatment. Interleukin-1 inhibitors show promise in reducing recurrence risk.
Area of Science:
- Cardiology
- Immunology
- Inflammation
Background:
- Acute pericarditis involves pericardial inflammation, with 16-38% of patients experiencing recurrent episodes.
- Recurrent pericarditis (RP) is linked to pathological immune responses and inadequate initial treatment, increasing recurrence risk.
- Diagnosis of RP often relies on imaging, particularly cardiac magnetic resonance, due to less severe symptoms compared to initial episodes.
Purpose of the Study:
- To review the understanding of recurrent pericarditis, including its causes, diagnosis, and treatment strategies.
- To highlight the role of imaging and inflammatory biomarkers in managing RP.
- To evaluate the efficacy of different treatment modalities, from first-line NSAIDs and colchicine to second-line glucocorticoids and novel IL-1 inhibitors.
Main Methods:
- Literature review focusing on the pathophysiology, diagnosis, and treatment of acute and recurrent pericarditis.
- Analysis of current treatment guidelines and emerging therapeutic options.
- Examination of the diagnostic utility of cardiac magnetic resonance and inflammatory biomarkers.
Main Results:
- Inadequate treatment increases the risk of pericarditis recurrence.
- Cardiac magnetic resonance is a key imaging tool for detecting active pericardial inflammation in RP.
- While NSAIDs and colchicine are first-line, glucocorticoids are associated with higher recurrence rates.
- Interleukin-1 inhibitors (anakinra, rilonacept) significantly decrease recurrence risk in patients with RP.
Conclusions:
- Recurrent pericarditis management requires careful consideration of treatment adequacy, diagnostic tools, and therapeutic options.
- Colchicine is crucial for reducing recurrence risk alongside NSAIDs.
- Interleukin-1 inhibitors represent a significant advancement in treating refractory recurrent pericarditis.
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