Recurrent Pericarditis
Section snippets
Introduction and search strategy
MEDLINE and Cochrane Library were systematically screened with specific terms “(recurrent pericarditis) AND (“2011”[pdat]:“2016”[pdat]) NOT (review[pt] OR editorial[pt] OR letter[pt])”. Non-humans studies, non-English language and duplicate reporting were excluded. Twenty-eight of 50 articles were rejected as being judged non pertinent for the present review by agreement between two authors (MI and EG). Pertinent articles were appraised as full text. Furthermore, the most relevant studies
Definition
Recurrent pericarditis is one of the most troublesome complication of pericarditis and should be distinguished from incessant pericarditis.1., 2.Incessant pericarditis refers to patients without remission or who have early reappearance of symptoms within 4 to 6 weeks after a documented first episode of pericarditis and it is often due to inappropriate treatment of pericarditis (e.g. an early discontinuation of anti-inflammatory therapy, low doses of drugs, lack of specific recommendations on
Clinical manifestations
The main clinical manifestation of recurrent pericarditis is the “pericardial” pain, which is similar in characteristics to the pain of acute pericarditis. The other typical manifestations of pericarditis, such as electrocardiographic changes, pericardial friction rub and pericardial effusion are typically less frequent in relapses than in the index attack. Usually, the clinical manifestations of pericarditis become more and more attenuated from one episode to a subsequent episode of recurrence.
Etiology
The etiology of recurrent pericarditis is not completely understood, although an immune-mediated pathogenesis is often presumed as also suggested by the findings of non-organ specific and anti-heart antibody in patients with recurrences, as well as the response to corticosteroids and colchicine therapy.1., 9., 10.
However, inadequate therapy of pericarditis, albeit often underestimated, may represent a main cause of recurrences. To this regard, low doses of anti-inflammatory drugs, short therapy
Diagnosis
The diagnosis of recurrent pericarditis is based on the demonstration of a previous episode of acute pericarditis associated with the finding of “pericarditic pain” and another finding of pericarditis [e.g. pericardial friction rub, electrocardiographic changes, new or worsening pericardial effusion, elevation of inflammation markers, as C-reactive protein (CRP) or white blood cell count] (Table 3).
In patients with repeated relapses, the diagnosis is mainly based on the confirmation of the
Therapy
The cornerstone of therapy for recurrences is physical restriction until symptoms resolution and C-reactive protein normalization in addition to an anti-inflammatory therapy based on aspirin or NSAID plus colchicine as first choice; then if the patient is not responding or has recurrences it is possible to add corticosteroids (Table 4).3., 4., 5., 6., 7.
The assessment of C-reactive protein values could be used for the initial diagnosis and to monitor the activity of the disease in order to
Outcomes and prognosis
The prognosis of idiopathic recurrent pericarditis is generally good without mortality and significant risk of constriction even despite several recurrences. Indeed, the risk of constriction does not depend on the number of relapses, but it is related to the etiology of pericarditis.2
Conclusions and perspectives
Recurrent pericarditis is the most common and troublesome complication of pericarditis affecting 20 to 50% of patients. Its pathogenesis is often presumed to be immune-mediated, but additional investigations are needed to clarify the pathogenesis in order to develop etiology-oriented therapies. Imaging with CT and especially CMR holds promise to help in the identification of more difficult cases and improve their management. Refractory recurrent pericarditis with corticosteroid dependence and
Statement of conflict of interest
None of the authors have any conflicts of interests with regard to this publication.
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Cited by (17)
CUPS to Manage Pericarditis
2021, Journal for Nurse PractitionersCitation Excerpt :Incessant pericarditis indicates that symptoms last for more than 4 to 6 weeks but less than 3 months. Incessant pericarditis becomes chronic pericarditis if symptoms persist beyond 3 months.8-10 Constrictive pericarditis is an outcome of inflammation that leads to the loss of elasticity and scarring of the pericardium, resulting in impaired ventricular diastolic filling.
Risk Factors for Morbidity and Mortality Following Hospitalization for Pericarditis
2020, Journal of the American College of CardiologyCitation Excerpt :This was similar to a randomized study from which the European Society of Cardiology guidelines have their data. This study estimated that 15% had recurrences in the first 18 months if they were treated with colchicine, but up to 30% had recurrences if not treated (1,2,27). The recurrence rate is lower in our study, which could be due to differences in study design, because we investigated only admission-required recurrent pericarditis, so there was likely an underestimation.
Clinical Update in Pericardial Diseases
2019, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :Recurrent pericarditis is defined as a recurrence of symptoms after a 4- to 6-week symptom-free period, and the rate of recurrence is approximately 20%-30% for patients after a single episode of pericarditis.1,13 However, after a first episode of recurrence, the likelihood of additional episodes may be as high as 50%.13 Recurrent episodes are defined using the same diagnostic criteria as mentioned previously for acute pericarditis.
Pericarditis. Clinical guidelines 2022
2023, Russian Journal of CardiologyInterleukin-1 Trap Rilonacept Improved Health-Related Quality of Life and Sleep in Patients With Recurrent Pericarditis: Results From the Phase 3 Clinical Trial RHAPSODY
2022, Journal of the American Heart Association
Statement of Conflict of Interest: See page 366.