Management of idiopathic recurrent pericarditis in adults and in children

a role for IL-1 receptor antagonism

Antonio Brucato, Giacomo Emmi, Luca Cantarini, Andrea Di Lenarda, Marco Gattorno, Giuseppe Lopalco, Renzo Marcolongo, Massimo Imazio, Alberto Martini, Domenico Prisco

Research output: Contribution to journalReview article

11 Citations (Scopus)

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 languageEnglish
Pages (from-to)475-489
Number of pages15
JournalInternal and Emergency Medicine
Volume13
Issue number4
DOIs
Publication statusPublished - Jun 1 2018

Fingerprint

Pericarditis
Interleukin-1 Receptors
Interleukin 1 Receptor Antagonist Protein
Cryopyrin-Associated Periodic Syndromes
Familial Mediterranean Fever
Colchicine
Interleukin-1
Developed Countries
Innate Immunity
Autoimmune Diseases
Rheumatoid Arthritis
Anti-Inflammatory Agents
Therapeutics
Cytokines
Inflammation
Physicians
Pharmaceutical Preparations

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 journalReview article

Brucato, A, Emmi, G, Cantarini, L, Di Lenarda, A, Gattorno, M, Lopalco, G, Marcolongo, R, Imazio, M, Martini, A & Prisco, D 2018, 'Management of idiopathic recurrent pericarditis in adults and in children: a role for IL-1 receptor antagonism', Internal and Emergency Medicine, vol. 13, no. 4, pp. 475-489. https://doi.org/10.1007/s11739-018-1842-x
Brucato, Antonio ; Emmi, Giacomo ; Cantarini, Luca ; Di Lenarda, Andrea ; Gattorno, Marco ; Lopalco, Giuseppe ; Marcolongo, Renzo ; Imazio, Massimo ; Martini, Alberto ; Prisco, Domenico. / Management of idiopathic recurrent pericarditis in adults and in children : a role for IL-1 receptor antagonism. In: Internal and Emergency Medicine. 2018 ; Vol. 13, No. 4. pp. 475-489.
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