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Acute recurrent pericarditis: from pathophysiology towards new treatment strategy
  1. Patrice Cacoub1,2,3,4,
  2. Cindy Marques1,2,3,4
  1. 1 Department of Internal Medicine and Clinial Immunology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine, Paris, France
  2. 2 Département Hospitalo-Universitaire I2, Sorbonne Université, UPMC Univ Paris 06, Paris, France
  3. 3 CNRS, UMR 7211, Paris, France
  4. 4 INSERM, UMR_S 959, F-75013, Paris, France
  1. Correspondence to Professor Patrice Cacoub, Internal Medicine and Clinical Immunology, Assistance Publique - Hopitaux de Paris, Paris 75004, France; patrice.cacoub{at}aphp.fr

Abstract

Acute idiopathic or so-called viral pericarditis is a frequent and usually benign disease, although recurrences are frequent. Data strongly suggest the presence of underlying autoinflammatory and/or autoimmune disorders. It has been reported that there is an inflammatory response of the innate immune system typical of ‘autoinflammatory diseases’, predominantly mediated by interleukin-1 (IL-1). This may result from the activation of the inflammasome by a cardiotropic virus or a non-specific agent. The inflammatory response of the adaptive immune system, typical of ‘autoimmune diseases’—mainly mediated by autoantibodies or autoreactive T lymphocytes—seems also involved as anti-heart or anti-intercalated disk autoantibodies were associated with a higher number of recurrences and hospitalisations. Current guidelines recommend that aspirin/non-steroidal anti-inflammatory drugs for a few weeks should be associated to colchicine for 6 months in recurrent pericarditis. In refractory cases, low-dose corticosteroids or immunosuppressive drugs have been proposed with limited efficacy. Growing evidences suggest a place of IL-1 receptor antagonists in the treatment of recurrent pericarditis. Many retrospective studies, one recent randomised placebo-controlled study and data of a real-life large international registry showed the good efficacy of anakinra with a good safety profile. Other IL-1 receptor antagonists showed promising results (canakinumab, rilonacept). However, IL-1 receptor antagonists’ position in the treatment algorithm of recurrent pericarditis needs further evaluation in larger prospective clinical trials to replicate initial findings as well as to assess safety, cost-effectiveness and long-term efficacy.

  • pericardial disease
  • pericardial effusion
  • systemic inflammatory diseases
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Footnotes

  • Contributors PC planned and conducted this analysis, and wrote the first draft. CM contributed to the final analysis and the writing of the final version. PC is responsible for the overall content as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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