Recurrent pericarditis: Infectious or autoimmune?

Antonio Brucato*, Silvia Maestroni, Davide Cumetti, Giuseppe Thiella, Gabriella Alari, Giovanni Brambilla, Massimo Imazio, Andrea Doria, Giancarlo Palmieri, Yehuda Adler

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)44-47
Number of pages4
JournalAutoimmunity Reviews
Volume8
Issue number1
DOIs
StatePublished - Oct 2008
Externally publishedYes

Keywords

  • Autoimmunity
  • Long term outcomes
  • Multidrug therapy
  • Pericarditis

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