Recurrent pericarditis: new and emerging therapeutic options

Abstract

Recurrent pericarditis is one of the most common and troublesome complications after an episode of pericarditis, and affects 20-50% of patients treated for pericarditis. In most of these patients, the pericarditis remains idiopathic, although an immune-mediated (either autoimmune or autoinflammatory) pathogenesis is often presumed. The mainstay of therapy for recurrences is aspirin or NSAIDs, with the adjunct of colchicine. Corticosteroids are a second-line option to be considered for specific indications, such as connective tissue disease or pregnancy; contraindications or intolerance to aspirin, NSAIDs, and/or colchicine; or insufficient response to these medications. Furthermore, corticosteroids can be added to NSAIDs and colchicine in patients with persistent symptoms. In patients who do not respond adequately to any of these conventional therapies, alternative treatment options include azathioprine, intravenous human immunoglobulins, and anakinra. An improved understanding of how recurrent pericarditis develops after an initiating event is critical to prevent this complication, and further research is needed into the pathogenesis of recurrences. We discuss the aetiology and diagnosis of recurrent pericarditis, and extensively review the treatment options for this condition.

Epicardial YAP/TAZ orchestrate an immunosuppressive response following myocardial infarction

“…Our findings directly inform potential therapeutic efforts that may be targeted to post-MI recovery through immunomodulation. It will be interesting to determine whether other important clinical syndromes including pericarditis (66,67), post-pericardiotomy syndrome (68), and Dressler syndrome (69), which share a hyperinflammatory pathophysiologic basis, may also benefit from enhanced Treg recruitment to the heart. Modulation of YAP/TAZ may be one method to regulate post-MI inflammation, but it will be important to more comprehensively understand the nonimmune roles of YAP/TAZ in the epicardium before conducting any human studies.…”

The Therapeutic Role of Interleukin-1 Inhibition in Idiopathic Recurrent Pericarditis: Current Evidence and Future Challenges

“…Recurrent pericarditis is a relatively common complication (15–30%) of acute pericarditis (1, 2). Usually occurs after a symptom-free interval of more than 4 weeks after the initial episode of acute pericarditis and may last for years (1, 2).…”

“…Usually occurs after a symptom-free interval of more than 4 weeks after the initial episode of acute pericarditis and may last for years (1, 2). Although in approximately 20% of patients, an initial viral etiology can be documented, in the majority of patients with recurrent pericarditis, no specific cause is identified and the disease is referred as “idiopathic recurrent pericarditis” (IRP) (1, 2). …”

“…Established therapeutic regimens like non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, and corticosteroids induce remission and cure in the majority of cases (1, 3). Nevertheless, a subset of patients either does not respond, relapse, or cannot tolerate the above therapeutic interventions (1, 3).…”

“…Nevertheless, a subset of patients either does not respond, relapse, or cannot tolerate the above therapeutic interventions (1, 3). In such patients, the disease usually follows a chronic, relapsing course posing a therapeutic challenge for treating physicians.…”