Long-term outcomes in difficult-to-treat patients with recurrent pericarditis.
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.
Brucato
Antonio
A
Department of Internal Medicine, Ospedale Niguarda, Milano, Department of Rheumatology, University of Padua, Italy. antonio.brucato@ospedaleniguarda.it
Brambilla
Giovanni
G
Moreo
Antonella
A
Alberti
Antonella
A
Munforti
Carlotta
C
Ghirardello
Anna
A
Doria
Andrea
A
Shinar
Yael
Y
Livneh
Avi
A
Adler
Yehuda
Y
Shoenfeld
Yehuda
Y
Mauri
Francesco
F
Palmieri
Giancarlo
G
Spodick
David H
DH
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
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000974:Antibodies, Antinuclear; D005938:Glucocorticoids