Recurrent pain without objective evidence of disease in patients with previous idiopathic or viral acute pericarditis
Recurrent pain without clinical evidence of acute pericarditis was recorded in 27 of 275 patients (9.8%; mean age 55.6 ± 16.0 years, female/male ratio 20/7) with previous viral or idiopathic acute pericarditis. Female gender (odds ratio [OR] 4.3, 95% confidence interval [CI] 1.8 to 10.6), previous use of corticosteroids (OR 5.2, 95% CI 2.2 to 12.3), and previous recurrent pericarditis (OR 3.7, 95% CI 1.3 to 10.2) were identified as risk factors for this syndrome. After a mean follow-up of 40 months, a higher recurrence rate was recorded in these patients (33.3% vs 14.1%; p = 0.02) as well as a nonsignificant trend to a higher rate of constrictive pericarditis.
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Cited by (38)
Recurrent pericarditis
2021, Medicine (Spain)La pericarditis recurrente es aquella en la que hay evidencia de un nuevo episodio de pericarditis, tras un período libre de síntomas de al menos 4-6 semanas, después de un primer diagnóstico de pericarditis aguda. La tasa de recurrencias es variable, y puede ocurrir hasta en la mitad de los casos después de una primera recurrencia en pacientes que reciben un tratamiento inadecuado. La fisiopatología es controvertida, y se ha postulado que un agente infeccioso actúa como desencadenante de una respuesta autoinmune o autoinflamatoria en pacientes susceptibles. Los criterios diagnósticos no difieren en gran medida de los empleados para el diagnóstico de un primer episodio de pericarditis aguda, y el tratamiento es superponible al tratamiento del episodio inicial. Sin embargo, en caso de múltiples recurrencias, deben tenerse en cuenta otras opciones terapéuticas, entre las que se encuentran los corticoides y los inmunosupresores y, como última opción, la pericardiectomía.
Recurrent pericarditis is pericarditis in which there is evidence of a new pericarditis episode following a symptoms-free period of at least four to six weeks following an initial diagnosis of acute pericarditis. The recurrence rate varies and it can occur in up to half of cases following a first recurrence in patients who receive inadequate treatment. The pathophysiology is controversial. It has been postulated that an infectious agent may trigger an autoimmune or autoinflammatory response in susceptible patients. The diagnostic criteria do not differ greatly from those used to diagnose an initial episode of acute pericarditis and treatment is able to be added to the treatment for the initial episode. However, in the case of multiple recurrences, other treatment options must be taken into account, included glucocorticoids and immunosuppressive agents and, as a last option, a pericardiectomy.
Assessment of Pericardial Disease with Cardiovascular MRI
2021, Heart Failure ClinicsColchicine Administered in the First Episode of Acute Idiopathic Pericarditis: A Randomized Multicenter Open-label Study
2019, Revista Espanola de CardiologiaSe dispone de poca información sobre el beneficio real de la administración de colchicina en el primer episodio de pericarditis aguda idiopática (PAI). El objetivo principal del presente estudio es evaluar la eficacia real de la colchicina en pacientes con PAI que no toman corticoides.
Estudio multicéntrico abierto y aleatorizado. Se aleatorizó en 2 grupos a los pacientes con un primer episodio de PAI (no secundario a lesión cardiaca o enfermedad del tejido conectivo): A, con tratamiento antiinflamatorio convencional más colchicina durante 3 meses, y B, con tratamiento antiinflamatorio convencional solamente. Ningún paciente tomaba corticoides. El objetivo primario del estudio fue la aparición de episodios recurrentes de pericarditis. El objetivo secundario fue el tiempo hasta la primera recurrencia. El seguimiento fue de 24 meses.
Se aleatorizó a 110 pacientes (el 83,6% varones; media de edad, 44 ± 18,3 años) a los grupos A (59 pacientes) y B (51 pacientes). No se encontraron diferencias entre ambos grupos en las características basales, las características clínicas del episodio índice o el tipo de tratamiento antiinflamatorio administrado. Completaron el seguimiento 102 pacientes (92,7%). No se encontraron diferencias entre los grupos en la tasa de pericarditis recurrente (12 pacientes [10,9%]; grupo A frente a grupo B, el 13,5 frente al 7,8%; p = 0,34). El tiempo hasta la primera recurrencia (9,6 ± 9.0 frente a 8,3 ± 10,5 meses; p = 0,80) no fue diferente entre los grupos.
En pacientes con un primer episodio de PAI que no habían tomado corticoides, no parece que la adición de colchicina al tratamiento antiinflamatorio convencional reduzca la tasa de recurrencias. Registro de ensayos clínicos: URL: https://www.clinicaltrialsregister.eu. Identificador: EudraCT 2009-011258-16.
There is a paucity of information about the real benefit of colchicine administration in the first episode of acute idiopathic pericarditis (AIP). The main objective of the present study was to assess the real efficacy of colchicine in patients with AIP who did not receive corticosteroids.
Randomized multicenter open-label study. Patients with a first episode of AIP (not secondary to cardiac injury or connective tissue disease) were randomized into 2 groups: group A received conventional anti-inflammatory treatment plus colchicine for 3 months, and group B received conventional anti-inflammatory treatment only. None of the patients received corticosteroids. The primary endpoint was the appearance of recurrent episodes of pericarditis. The secondary endpoint was the time to first recurrence. Follow-up was extended to 24 months.
A total of 110 patients (83.6% men, age 44 ± 18.3 years) were randomized to group A (n = 59) and group B (n = 51). No differences were found in baseline demographics or in the clinical features of the index episode or in the type of anti-inflammatory treatment administered in both groups. The follow-up was completed by 102 patients (92.7%). No differences were found in the rate of recurrent pericarditis between groups (12 patients [10.9%]; group A vs group B, 13.5% vs 7.8%; P = .34). The time to first recurrence (group A vs group B, 9.6 ± 9.0 vs 8.3 ± 10.5 months; P = .80) did not differ between groups.
Among patients with a first episode of AIP who had not received corticosteroids, the addition of colchicine to conventional anti-inflammatory treatment does not seem to reduce the recurrence rate. Clinical trial registration: URL: https://www.clinicaltrialsregister.eu. Identifier: EudraCT 2009-011258-16.
Full English text available from:www.revespcardiol.org/en
Corticosteroids and immunosuppressive agents for idiopathic recurrent pericarditis
2019, Autoimmunity ReviewsRecurrent pericarditis is a frequent and troublesome complication of acute pericarditis. Aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine are the mainstay of therapy but few data is available on second-line treatment. We retrospectively analyzed 13 patients, 7 females (54%), median age 40 years, with a median of 4 (IQR 1–6) recurrences per patient despite a well conducted first-line treatment and a median follow-up of 59 months (IQR 38–70). Ten patients received corticosteroids as second-line therapy; 6 out of 10 responded to this therapy while 4 needed the addition of azathioprine. Three other patients received an immunosuppressive agent as second-line therapy (azathioprine, methotrexate, mycophenolate mofetyl). Overall, the mean frequency per month (± SD) of pericarditis recurrences was 0.69 (± 0.40) with aspirin/NSAIDs and colchicine, 0.22 (± 0.34) with corticosteroids alone and 0.01 (± 0.04) with immunosuppressive agents (p < 10−4). Immunosuppressive agents including azathioprine, methotrexate and mycophenolate mofetyl seem efficacious and well tolerated in patients with idiopathic recurrent pericarditis unresponsive to corticosteroids, corticosteroids-dependent or when corticosteroids side effects are judged unacceptable.
Recurrent pericarditis
2017, Revue de Medecine InterneRecurrent pericarditis is the most troublesome complication of pericarditis occurring in 15 to 30% of cases. The pathogenesis is often presumed to be immune-mediated although a specific rheumatologic diagnosis is commonly difficult to find. The clinical diagnosis is based on recurrent pericarditis chest pain and additional objective evidence of disease activity (e.g. pericardial rub, ECG changes, pericardial effusion, elevation of markers of inflammation, and/or imaging evidence of pericardial inflammation by CT or cardiac MR). The mainstay of medical therapy for recurrent pericarditis is aspirin or a non-steroidal anti-inflammatory drug (NSAID) plus colchicine. Second-line therapy is considered after failure of such treatments and it is generally based on low to moderate doses of corticosteroids (e.g. prednisone 0.2 to 0.5 mg/kg/day or equivalent) plus colchicine. More difficult cases are treated with combination of aspirin or NSAID, colchicine and corticosteroids. Refractory cases are managed by alternative medical options, including azathioprine, or intravenous human immunoglobulins or biological agents (e.g. anakinra). When all medical therapies fail, the last option may be surgical by pericardiectomy to be recommended in well-experienced centres. Despite a significant impairment of the quality of life, the most common forms of recurrent pericarditis (usually named as “idiopathic recurrent pericarditis” since without a well-defined etiological diagnosis) have good long-term outcomes with a negligible risk of developing constriction and rarely cardiac tamponade during follow-up. The present article reviews current knowledge on the definition, diagnosis, aetiology, therapy and prognosis of recurrent pericarditis with a focus on the more recent available literature.
Acute Pericarditis
2017, Progress in Cardiovascular DiseasesCitation Excerpt :In most of the cases, recurrent pericarditis is an autoimmune or immune mediated process. The etiology cannot be identified if patients are immunocompetent.1,67 The reasons for many cases of recurrent pericarditis are inadequate treatment with anti-inflammatory medications.
Acute pericarditis is an acute inflammatory disease of the pericardium, which may occur in many different disease states (both infectious and non-infectious). Usually the diagnosis is based on symptoms (chest pain, shortness of breath), electrocardiographic changes (ST elevation), physical examination (pericardial friction rub) and elevation of cardiac biomarkers. It may occur in isolation or be associated with an underlying inflammatory disorder. In routine clinical practice, acute pericarditis can be associated with myocarditis due to their overlapping etiologies.