Abstract
Recurrent pericarditis is one of the most frequent pericardial diseases, affecting up to 30% of the patients who have experienced acute pericarditis. While the diagnosis of acute pericarditis is sometime straight forward, its etiology and therapeutic management are still a challenge for physicians. In developed countries, the idiopathic form is the most frequent, and the search for an infectious etiology is almost invariably negative. Nevertheless, since standard treatment with nonsteroidal anti-inflammatory drugs and colchicine is not always able to neutralize pericardial inflammation in recurrent pericarditis, anakinra, an IL-1 receptor antagonist, has been proposed as a possible therapeutic alternative for refractory forms. IL-1 is a cytokine that exerts a pivotal role in innate immunity and in the pathogenesis of some autoimmune diseases, such as rheumatoid arthritis, and in autoinflammatory disorders, as familial Mediterranean fever and cryopyrin-associated periodic syndromes. The successful management of patients with acute idiopathic recurrent pericarditis (IRP) needs a teamwork approach, where cardiologists, rheumatologists, clinical immunologists and internists are involved. In this review, we will discuss the clinical and therapeutical challenges of IRP both in adults and children from a clinical practice standpoint. We will also briefly illustrate the main pathogenic mechanisms of IRP to provide internists and cardiologists with the rationale for approaching the use of anakinra in selected clinical cases.
| Original language | English |
|---|---|
| Pages (from-to) | 475-489 |
| Number of pages | 15 |
| Journal | Internal and Emergency Medicine |
| Volume | 13 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Jun 1 2018 |
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Keywords
- Anakinra
- Autoimmune diseases
- Autoinflammatory diseases
- Interleukin-1Ra
- Pericardial diseases
- Recurrent pericarditis
ASJC Scopus subject areas
- Internal Medicine
- Emergency Medicine
Cite this
Management of idiopathic recurrent pericarditis in adults and in children : a role for IL-1 receptor antagonism. / Brucato, Antonio; Emmi, Giacomo; Cantarini, Luca; Di Lenarda, Andrea; Gattorno, Marco; Lopalco, Giuseppe; Marcolongo, Renzo; Imazio, Massimo; Martini, Alberto; Prisco, Domenico.
In: Internal and Emergency Medicine, Vol. 13, No. 4, 01.06.2018, p. 475-489.Research output: Contribution to journal › Review article
}
TY - JOUR
T1 - Management of idiopathic recurrent pericarditis in adults and in children
T2 - a role for IL-1 receptor antagonism
AU - Brucato, Antonio
AU - Emmi, Giacomo
AU - Cantarini, Luca
AU - Di Lenarda, Andrea
AU - Gattorno, Marco
AU - Lopalco, Giuseppe
AU - Marcolongo, Renzo
AU - Imazio, Massimo
AU - Martini, Alberto
AU - Prisco, Domenico
PY - 2018/6/1
Y1 - 2018/6/1
N2 - Recurrent pericarditis is one of the most frequent pericardial diseases, affecting up to 30% of the patients who have experienced acute pericarditis. While the diagnosis of acute pericarditis is sometime straight forward, its etiology and therapeutic management are still a challenge for physicians. In developed countries, the idiopathic form is the most frequent, and the search for an infectious etiology is almost invariably negative. Nevertheless, since standard treatment with nonsteroidal anti-inflammatory drugs and colchicine is not always able to neutralize pericardial inflammation in recurrent pericarditis, anakinra, an IL-1 receptor antagonist, has been proposed as a possible therapeutic alternative for refractory forms. IL-1 is a cytokine that exerts a pivotal role in innate immunity and in the pathogenesis of some autoimmune diseases, such as rheumatoid arthritis, and in autoinflammatory disorders, as familial Mediterranean fever and cryopyrin-associated periodic syndromes. The successful management of patients with acute idiopathic recurrent pericarditis (IRP) needs a teamwork approach, where cardiologists, rheumatologists, clinical immunologists and internists are involved. In this review, we will discuss the clinical and therapeutical challenges of IRP both in adults and children from a clinical practice standpoint. We will also briefly illustrate the main pathogenic mechanisms of IRP to provide internists and cardiologists with the rationale for approaching the use of anakinra in selected clinical cases.
AB - Recurrent pericarditis is one of the most frequent pericardial diseases, affecting up to 30% of the patients who have experienced acute pericarditis. While the diagnosis of acute pericarditis is sometime straight forward, its etiology and therapeutic management are still a challenge for physicians. In developed countries, the idiopathic form is the most frequent, and the search for an infectious etiology is almost invariably negative. Nevertheless, since standard treatment with nonsteroidal anti-inflammatory drugs and colchicine is not always able to neutralize pericardial inflammation in recurrent pericarditis, anakinra, an IL-1 receptor antagonist, has been proposed as a possible therapeutic alternative for refractory forms. IL-1 is a cytokine that exerts a pivotal role in innate immunity and in the pathogenesis of some autoimmune diseases, such as rheumatoid arthritis, and in autoinflammatory disorders, as familial Mediterranean fever and cryopyrin-associated periodic syndromes. The successful management of patients with acute idiopathic recurrent pericarditis (IRP) needs a teamwork approach, where cardiologists, rheumatologists, clinical immunologists and internists are involved. In this review, we will discuss the clinical and therapeutical challenges of IRP both in adults and children from a clinical practice standpoint. We will also briefly illustrate the main pathogenic mechanisms of IRP to provide internists and cardiologists with the rationale for approaching the use of anakinra in selected clinical cases.
KW - Anakinra
KW - Autoimmune diseases
KW - Autoinflammatory diseases
KW - Interleukin-1Ra
KW - Pericardial diseases
KW - Recurrent pericarditis
UR - http://www.scopus.com/inward/record.url?scp=85045114393&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85045114393&partnerID=8YFLogxK
U2 - 10.1007/s11739-018-1842-x
DO - 10.1007/s11739-018-1842-x
M3 - Review article
VL - 13
SP - 475
EP - 489
JO - Internal and Emergency Medicine
JF - Internal and Emergency Medicine
SN - 1828-0447
IS - 4
ER -