title: Idiopathic recurrent pericarditis as an immune-mediated disease: current insights into pathogenesis and emerging treatment options.
abstract: Idiopathic recurrent pericarditis affects 30-50% of patients with a previous attack of pericarditis. The etiopathogenesis is incompletely understood and most cases remain idiopathic with a presumed immune-mediated pathogenesis. The mainstay of therapy is aspirin or a nonsteroidal anti-inflammatory drug plus colchicine and the possible adjunct of a low-to-moderate dose of a corticosteroid in more difficult cases. Colchicine as an adjunct to anti-inflammatory therapy reduces by 50% the subsequent recurrent rate. For true refractory cases with failure of standard combination therapies, new and emerging options especially include human intravenous immunoglobulins and biological agents (i.e., anakinra). The outcome of idiopathic recurrent pericarditis is good with a negligible risk of developing constrictive pericarditis. Thus, it is important to reassure patients on their prognosis, explaining the nature of the disease and the likely course. Moreover, therapeutic choices should include less toxic agents and favor cheaper drugs whenever possible.
authors.affiliation: Cardiology Department, Maria Vittoria Hospital and University of Torino, Via Luigi Cibrario 72, 10141 Torino, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Imazio
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D003078:Colchicine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D053590:Interleukin 1 Receptor Antagonist Protein / Q000627:therapeutic use*; D010494:Pericarditis, Constrictive / Q000188:drug therapy* / Q000276:immunology*; D012008:Recurrence; D050257:Tubulin Modulators / Q000627:therapeutic use
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D053590:Interleukin 1 Receptor Antagonist Protein; D050257:Tubulin Modulators; D001241:Aspirin; D003078:Colchicine
keywords: pathogenesis; recurrent pericarditis; therapy