Management of idiopathic recurrent pericarditis in adults and in children: a role for IL-1 receptor antagonism.

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.

• Authors: Antonio Brucato, Giacomo Emmi, Luca Cantarini, Andrea Di Lenarda, Marco Gattorno, Giuseppe Lopalco, Renzo Marcolongo, Massimo Imazio, Alberto Martini, Domenico Prisco
• Journal: Internal and emergency medicine (Intern Emerg Med) Vol. 13 Issue 4 Pg. 475-489 (06 2018) ISSN: 1970-9366 [Electronic] Italy
• PMID: 29633070 (Publication Type: Journal Article, Review)

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Antirheumatic Agents
• Biomarkers
• IL1R1 protein, mouse
• Interleukin 1 Receptor Antagonist Protein
• Receptors, Interleukin-1 Type I
• C-Reactive Protein
• Aspirin
• Colchicine

Topics

• Adolescent
• Adult
• Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
• Antirheumatic Agents (therapeutic use)
• Aspirin (therapeutic use)
• Biomarkers (analysis, blood)
• C-Reactive Protein (analysis)
• Child
• Child, Preschool
• Colchicine (therapeutic use)
• Global Health (trends)
• Humans
• Immunity, Innate
• Interleukin 1 Receptor Antagonist Protein (therapeutic use)
• Middle Aged
• Pericarditis (diagnosis, immunology, physiopathology)
• Receptors, Interleukin-1 Type I (antagonists & inhibitors)
• Recurrence
• Risk Factors