Download PDF
Arthritis und Rheuma 2016; 36(05): 339-343
DOI: 10.1055/s-0037-1617752
Kinderrheumatologie/Übersichtsartikel
Schattauer GmbH

Idiopathische rekurrente Perikarditis

Idiopathic recurrent pericarditis
M. Prelog
1   Universitäts-Kinderklinik Würzburg, Universitätsklinikum Würzburg
› Author Affiliations
Further Information

Publication History

Publication Date:
20 December 2017 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die idiopathische rekurrente Perikarditis (IRP) stellt ein herausforderndes Krankheitsbild für Diagnostik und Therapie dar. Die IRP betrifft 10–50 % der Patienten mit einer vorhergehenden Perikarditis, wobei die Ätiopathogenese häufig als immunmediiert verstanden wird. Die Hauptsäulen der Therapie bestehen aus Acetylsalicylsäure und nichtsteroidalen antiinflammatorischen Medikamenten (NSAR) plus Colchizin und niedrig-bis mittelhoch dosierten Kortikosteroiden als Zweitlinientherapie. Intravenöse Immunglobuline und Azathioprin stellen weitere Therapieoptionen dar. In Anbetracht möglicher Aktivierungen des Inflammasoms werden zunehmend mit Erfolg Biologika eingesetzt, die gegen Interleukin (IL)-1 vermittelte Mechanismen gerichtet sind. Erfahrungen zeigen Erfolge für die Behandlung der kortikosteroidabhängigen IRP mit Anakinra, einem IL-1-Rezeptor-Antagonisten. Die Prognose der pädiatrischen IRP ist generell gut mit seltenen Episoden einer Perikardtamponade und einem geringen Risiko der konstriktiven Perikarditis.

Summary

The idiopathic recurrrent pericarditis (IRP) displays a challenging disease regarding diagnostic and therapeutic issues. The IRP affects 10 to 50 % of patients with previous pericarditis. The etiopathogenesis is mainly autoimmune or autoinflammatory. The basics of therapy are aspirin and non-steroidal antiinflammatory-drugs (NSAID) plus colchicine. Low-dose to moderate-dose corticosteroids are second-line therapy. Alternatively, intravenous immunoglobulins and azathioprin may be administered. Considering the possible activation of the inflammasome in the etiopathogenesis of IRP, biologics directed against Interleukin (IL)-1-mediated mechanisms are successfully used, particularly, anakinra, an IL-1-receptor antagonist, in corticosteroid-dependent forms of IRP. The prognosis of IRP is generally good with rare events of pericardial tamponade and a low risk of constrictive pericarditis.

Schlüsselwörter

Idiopathische rekurrente Perikarditis - NSAR - Colchizin - Acetylsalicylsäure - Interleukin-1

Keywords

Idiopathic recurrrent pericarditis - NSAID - colchicine - acetylsalicylic acid - Interleukin-1
 

  • Literatur

  • 1 Imazio M. Idiopathic recurrent pericarditis as an immune-mediated disease: current insights into pathogenesis and emerging treatment options. Expert Rev Clin Immunol 2014; 10: 1487-1492.
    CrossrefPubMedSearch in Google Scholar
  • 2 Cantarini L, Lopalco G, Selmi C. et al. Autoimmunity and autoinflammataion as the yin and yang of idiopathic recurrrent acute pericarditis. Autoimm Rev 2015; 14: 90-97.
    CrossrefPubMedSearch in Google Scholar
  • 3 Imazio M, Gaita F, LeWinter M. Evaluation and treatment of pericarditis: A systematic review. JAMA 2015; 314: 1498-1506.
    CrossrefPubMedSearch in Google Scholar
  • 4 Adler Y, Imazio M. Recurrent pericarditis. www.uptodate.com access date: 05.09.2016.
  • 5 Alraies MC, AlJaroudi W, Yarmohammadi H. et al. Usefulness of cardiac magnetic resonance-guided management in patients with recurrent pericarditis. Am J Cardiol 2015; 115: 542-547.
    CrossrefPubMedSearch in Google Scholar
  • 6 Imazio M, Bobbio M, Cecchi E. et al. Colchicine as first-choice therapy for recurrent pericarditis: results of the CORE (COlchicine für REcurrent Pericarditis) trial. Arch Intern Med 2005; 165: 1987-1991.
    CrossrefPubMedSearch in Google Scholar
  • 7 Imazio M, Burcato A, Cemin R. CORP (COlchicine for Recurrent Pericarditis) Investigators. Colchicine for recurrent pericarditis (CORP): a randomized trial. Ann Intern Med 2011; 155: 409-414.
    CrossrefPubMedSearch in Google Scholar
  • 8 Imazio M, Belli R, Brucato A. et al. Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis (CORP-2): a multicentre, double-blind, placebo-controlled, randomised trial. Lancet 2014; 282: 2232-2237.
    Search in Google Scholar
  • 9 Imazio M, Brucato A, Forno D. et al. Efficacy and safety of colchicine for pericarditis prevention. Systematic review and meta-analysis. Heart 2012; 98: 1078-1082.
    CrossrefPubMedSearch in Google Scholar
  • 10 Alabed S, Cabello JB, Irving GJ. et al. Colchicine for pericarditis. Cochrane Database Syst Rev. 2014: CD010652.
    PubMedSearch in Google Scholar
  • 11 Imazio M, Lazaros G, Brucato A, Gaita F. Recurrent pericarditis: new and emerging therapeutic options. Nat Rev Cardiol 2016; 13: 99-105.
    CrossrefPubMedSearch in Google Scholar
  • 12 Adler Y, Charron P, Imazio M. et al. European Society of Cardiology (ESC). 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The task force for the diagnosis and management of pericardial disease of the European Society of Cardiology (ESC) endorsed by: The European Association for Cardio-Thoracic Surgery (AECTS). Eur Heart J 2015; 36: 2921-2964.
    CrossrefPubMedSearch in Google Scholar
  • 13 Maisch B, Ristic AD, Pankuweit S. Intrapericardial treatment of autoreactive pericardial effusion with triamcinolone; the way to avoid side effects of systemic corticosteroid therapy. Eur Heart J 2002; 23: 1503-1508.
    CrossrefPubMedSearch in Google Scholar
  • 14 Peterlana D, Puccetti A, Simeoni S. et al. Efficacy of intravenous immunoglobulin in chronic idiopathic pericarditis: report of four cases. Clin Rheumatol 2005; 24: 18-21.
    CrossrefPubMedSearch in Google Scholar
  • 15 Picco P, Brisca G, Traverso F. et al. SUccessful treatment of idiopathic recurrent pericarditis in children with interleukin-1beta receptor antagonist (anakinra). Arthr Rheum 2009; 60: 264-268.
    CrossrefPubMedSearch in Google Scholar
  • 16 Vassilopoulos D, Lazaros G, Tsioufis C. et al. Successful treatment of adult patients with idiopathic recurrent pericarditis with an interleukin-1 receptor antagonist (anakinra). Int J Cardiol 2012; 160: 66-68.
    CrossrefPubMedSearch in Google Scholar
  • 17 Scardapane A, Brucato A, Chiarelli F, Breda L. Efficacy of an interleukin-beta receptor antagonist (anakinra) in idiopathic recurrent pericarditis. Pediatr Cardiol 2013; 34: 1989-1991.
    CrossrefPubMedSearch in Google Scholar
  • 18 Baskar S, Klein AL, Zeft A. The use of IL-1 receptor anatagonist (anakinra) in idiopathic recurrent pericarditis: a narrative review. Cardiol Res Pract. 2016 article ID: 7840724.
    PubMedSearch in Google Scholar
  • 19 Jain S, Thongprayoon C, Espinosa RE. et al. Effectiveness and safety of anakinra for management of refractory pericarditis. Am J Cardiol 2015; 116: 1277-1279.
    CrossrefPubMedSearch in Google Scholar
  • 20 Finetti M, Insalaco A, Cantarini L. et al. Long-term efficacy of interleukin-1 receptor antagonist (anakinra) in corticosteroid-dependent and colchicine-resistant recurrent pericarditis. J Pediatr 2014; 164: 1425-1431.
    CrossrefPubMedSearch in Google Scholar
  • 21 Imazio M, Bobbio M, Cecchi E. et al. Colchicine in addition to conventional therapy for acute pericarditis results of the COlchicine for acute PEricarditis (COPE) trial. Circulation 2005; 112: 2012-2017.
    CrossrefPubMedSearch in Google Scholar
  • 22 Lange RA, HIllis LD. Clinical practice. Acute pericarditis. N Engl J Med 2004; 351: 2195-2202.
    CrossrefPubMedSearch in Google Scholar
  • 23 Brucato A, Brambilla G, Moreo A. et al. Long-term outcomes in difficult-to-treat patients with recurrent pericarditis. Am J Cardiol 2006; 98: 267-271.
    CrossrefPubMedSearch in Google Scholar