Recurrent pericarditis: infectious or autoimmune?
The etiology and pathogenesis of idiopathic recurrent acute pericarditis (IRAP) remain controversial standing like a bridge that crosses infectious, autoimmune and autoinflammatory pathways. Anything may cause acute pericarditis; Echo-virus, and Coxsackie are the most frequently involved viruses, Mycobacterium tuberculosis and Coxiella burnetii the most common bacteria, but in 85% of cases it remains "idiopathic". Recurrences occur in up to 20-50% of patients. An immuno-mediated pathogenesis is suggested by the presence of pro-inflammatory cytokines in pericardial fluid, the presence of antinuclear autoantibodies (ANA) in sera of the patients, the occurrence of new autoimmune diagnoses and the good response to anti-inflammatory or immunosuppressive therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs) must be used at recommended dosages, till the resolution of symptoms and normalization of C-reactive protein and erythrocyte sedimentation rate. Corticosteroids should be used rarely, at low doses, with an extremely low tapering and with osteoporosis prevention. Colchicine leads to a clinically important and statistically significant benefit, reducing recurrences by 50%. The long term outcome of IRAP is good, without evidence of constriction even after a very long follow-up.
Brucato
Antonio
A
Department of Internal Medicine, Ospedali Riuniti di Bergamo, Bergamo, Italy. albrucato@ospedaliriuniti.bergamo.it
Maestroni
Silvia
S
Cumetti
Davide
D
Thiella
Giuseppe
G
Alari
Gabriella
G
Brambilla
Giovanni
G
Imazio
Massimo
M
Doria
Andrea
A
Palmieri
Giancarlo
G
Adler
Yehuda
Y
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000974:Antibodies, Antinuclear / Q000096:biosynthesis / Q000276:immunology*; D001424:Bacterial Infections / Q000276:immunology*; D002097:C-Reactive Protein / Q000378:metabolism; D003078:Colchicine / Q000627:therapeutic use; D016997:Coxiella burnetii; D004347:Drug Interactions; D004770:Enterovirus / Q000276:immunology*; D004769:Enterovirus Infections / Q000276:immunology*; D006801:Humans; D009169:Mycobacterium tuberculosis; D010024:Osteoporosis / Q000517:prevention & control; D010493:Pericarditis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D011379:Prognosis; D055502:Secondary Prevention; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000974:Antibodies, Antinuclear; D002097:C-Reactive Protein; D003078:Colchicine