title: Long-term outcomes in difficult-to-treat patients with recurrent pericarditis.
abstract: Patients with many recurrences of acute pericarditis are commonly alarmed by the fear of constriction. We studied their long-term outcome and the possible presence of systemic diseases. Sixty-one Italian patients (36 men) were followed for an average of 8.3 years according to a predefined protocol, including testing for autoimmune diseases and familial Mediterranean fever. Symptomatic pericarditis lasted from 1 to 43 years (mean 5.4 years). Fifty-two patients had been referred to us after failure of previous therapies, including steroids. We observed 378 attacks with a mean of 1.6 per patient per year and 156 hospital admissions. Thirteen patients had a post-cardiac injury syndrome. In 43 (70.5%), the pericarditis remained idiopathic, whereas we made a new diagnosis of rheumatoid arthritis in 1 and of Sjogren's syndrome in 4 patients, but in these patients pericarditis represented the dominant clinical manifestation. Cardiac tamponade occurred during the initial attacks in 4 patients (6.5%) but never recurred. Pleural effusions were present during the first attack in 22 patients (36.0%) and liver involvement in 5 (8%). No patients developed constrictive pericarditis. Echocardiographic examination produced no evidence of chronic myocardial disease. Response to therapy was good. Thirty-one patients (50.8%) are in sustained remission, without any therapy; their total observation period has averaged 10.3 years. In idiopathic patients, antinuclear antibodies were present in 56.2% and anti-Ro/SSA in 8.3%. Mutations linked to familial Mediterranean fever were absent. In conclusion, in this large series of difficult patients with recurrent acute pericarditis and a very long follow-up, the long-term prognosis is good.
authors.affiliation: Department of Internal Medicine, Ospedale Niguarda, Milano, Department of Rheumatology, University of Padua, Italy. antonio.brucato@ospedaleniguarda.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Brucato
authors.forename: Giovanni
authors.initials: G
authors.lastname: Brambilla
authors.forename: Antonella
authors.initials: A
authors.lastname: Moreo
authors.forename: Antonella
authors.initials: A
authors.lastname: Alberti
authors.forename: Carlotta
authors.initials: C
authors.lastname: Munforti
authors.forename: Anna
authors.initials: A
authors.lastname: Ghirardello
authors.forename: Andrea
authors.initials: A
authors.lastname: Doria
authors.forename: Yael
authors.initials: Y
authors.lastname: Shinar
authors.forename: Avi
authors.initials: A
authors.lastname: Livneh
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Adler
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Shoenfeld
authors.forename: Francesco
authors.initials: F
authors.lastname: Mauri
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Palmieri
authors.forename: David H
authors.initials: DH
authors.lastname: Spodick
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000974:Antibodies, Antinuclear / Q000032:analysis; D002648:Child; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D004452:Echocardiography; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010493:Pericarditis / Q000175:diagnosis / Q000188:drug therapy*; D011379:Prognosis; D012008:Recurrence; D013997:Time Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000974:Antibodies, Antinuclear; D005938:Glucocorticoids