Öz
Objective: In this study, we aimed to evaluate the clinical findings and follow-up data of children with recurrent pericarditis (RP).
Material and Methods: This study had a retrospective design and included pediatric patients with recurrent pericarditis evaluated between January 2017 to January 2023. The initial diagnosis of pericarditis was made according to the criteria determined in the European Society of Cardiology guideline.
Results: We enrolled 16 children (14 males) with recurrent pericarditis with median age 12.8 (8 – 17) years. Eight patients (50%) presented with fever, pericardial effusion in 11 patients (68.7%). Pericardiocentesis was performed in 9 (56.2%) patients. The median erythrocyte sedimentation rate (ESR); C-reactive protein (CRP) levels at the time of diagnosis were 43 (25-70) mm/h and 107 (61-190) mg/dl, respectively. In total, 16 patients had 36 recurrences during follow-up. The main symptom during the relapses was chest pain, similar to that of the first attack. Four patients (25%) had a history of previous cardiac surgery. Three patients were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) only. NSAID and colchicine were administered to 13 patients. One patient received corticosteroid and one patient received anakinra treatment.
Conclusion: Patients with recurrent pericarditis in childhood have an autoinflammatory phenotype. Furthermore, successful management of patients with recurrent pericarditis requires a teamwork approach involving cardiologists, rheumatologists and clinical immunologists.
Anahtar Kelimeler: Autoinflammation, childhood, colchicine, pericarditis
Kaynakça
- Troughton RW, Asher CR, Klein AL. Pericarditis. The Lancet. 2004;363 (9410):717-27. https://doi.org/10.1016/S0140-6736(04)15648-1
- Brucato A, Brambilla G, Moreo A, et al. Long-term outcomes in difficult-to-treat patients with recurrent pericarditis. The American journal of cardiology. 2006;98 (2):267-71. https://doi.org/10.1016/j.amjcard.2006.01.086
- Imazio M, Spodick DH, Brucato A, et al. Controversial issues in the management of pericardial diseases. Circulation. 2010;121 (7):916-28. https://doi.org/10.1161/CIRCULATIONAHA.108.844753
- Brucato A, Emmi G, Cantarini L, et al. Management of idiopathic recurrent pericarditis in adults and in children: a role for IL-1 receptor antagonism. Intern Emerg Med. 2018;13:475-89. https://doi.org/10.1007/s11739-018-1842-x
- Ratnapalan S, Brown K, Benson L. Children presenting with acute pericarditis to the emergency department. Pediatr Emerg Care. 2011;27 (7):581-5. https://doi.org/10.1097/PEC.0b013e31822251ba
- Imazio M, Brucato A, Maestroni S, et al. Risk of constrictive pericarditis after acute pericarditis. Circulation. 2011;124 (11):1270-5. https://doi.org/10.1161/CIRCULATIONAHA.111.018580
- Imazio M, Brucato A, Maestroni S, et al. Prevalence of C-reactive protein elevation and time course of normalization in acute pericarditis: implications for the diagnosis, therapy, and prognosis of pericarditis. Circulation. 2011;123(10):1092-7. https://doi.org/10.1161/CIRCULATIONAHA.110.986372
- Cantarini L, Imazio M, Brizi MG, et al. Role of autoimmunity and autoinflammation in the pathogenesis of idiopathic recurrent pericarditis. Clin Rev Allergy Immunol. 2013;44:6-13. https://doi.org/10.1007/s12016-010-8219-x
- Cantarini L, Lucherini OM, Brucato A, et al. Clues to detect tumor necrosis factor receptor-associated periodic syndrome (TRAPS) among patients with idiopathic recurrent acute pericarditis: results of a multicentre study. Clin Res Cardiol. 2012;101:525-31. https://doi.org/10.1007/s00392-012-0422-8
- Cantarini L, Lopalco G, Selmi C, et al. Autoimmunity and autoinflammation as the yin and yang of idiopathic recurrent acute pericarditis. Autoimmun Rev. 2015;14(2):90-7. https://doi.org/10.1016/j.autrev.2014.10.005
- Imazio M, Brucato A, Pluymaekers N, et al. Recurrent pericarditis in children and adolescents: a multicentre cohort study. J Cardiovasc Med. 2016;17 (9):707-12. https://doi.org/10.2459/JCM.0000000000000300
- Imazio M, Lazaros G, Brucato A, et al. Recurrent pericarditis: new and emerging therapeutic options. Nature Reviews Cardiology. 2016;13:99-105. https://doi.org/10.1038/nrcardio.2015.115
- Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases. Kardiologia Polska (Polish Heart Journal). 2015;73(11):1028-91. https://doi.org/10.5603/KP.2015.0228
- 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;383 (9936):2232-7. https://doi.org/10.1016/S0140-6736(13)62709-9
- Lopalco G, Rigante D, Cantarini L, et al. The autoinflammatory side of recurrent pericarditis: Enlightening the pathogenesis for a more rational treatment. Trends Cardiovasc Med. 2021;31(5):265-74. https://doi.org/10.1016/j.tcm.2020.04.006
- Andreis A, Imazio M, De Ferrari GM. Contemporary diagnosis and treatment of recurrent pericarditis. Expert Rev Cardiovasc Ther. 2019;17:817-826. https://doi.org/10.1080/14779072.2019.1691916
- Raatikka M, Pelkonen PM, Karjalainen J, et al. Recurrent pericarditis in children and adolescents: report of 15 cases. J Am Coll Cardiol. 2003;42(4):759-64. https://doi.org/10.1016/S0735-1097(03)00778-2
- Kees S, Langevitz P, Zemer D, et al. Attacks of pericarditis as a manifestation of familial Mediterranean fever (FMF). QJM: An International Journal of Medicine. 1997;90(10):643-7. https://doi.org/10.1093/qjmed/90.10.643
- Magnotti F, Vitale A, Rigante D, et al. The most recent advances in pathophysiology and management of tumour necrosis factor receptor-associated periodic syndrome (TRAPS): personal experience and literature review. Clin Exp Rheumatol. 2013;31:141-9.
- Imazio M, Trinchero R, Shabetai R. Pathogenesis, management, and prevention of recurrent pericarditis. J Cardiovasc Med. 2007;8(6):404-10. https://doi.org/10.2459/01.JCM.0000269708.72487.34
- PJ H. The effective treatment of postpericardiotomy syndrome after cardiac operations. J Thorac Cardiovasc Surg. 1990;100(2):292-6. https://doi.org/10.1016/S0022-5223(19)35571-0
- Lotrionte M, Biondi-Zoccai G, Imazio M, et al. International collaborative systematic review of controlled clinical trials on pharmacologic treatments for acute pericarditis and its recurrences. Am Heart J. 2010;160(4):662-70. https://doi.org/10.1016/j.ahj.2010.06.015
- Imazio M, Bobbio M, Cecchi E, et al. Colchicine as first-choice therapy for recurrent pericarditis: results of the CORE (COlchicine for REcurrent pericarditis) trial. Arch Intern Med. 2005;165(17):1987-91. https://doi.org/10.1001/archinte.165.17.1987
- Imazio M, Brucato A, Cemin R, et al. Colchicine for recurrent pericarditis (CORP) a randomized trial. Ann Intern Med. 2011;155(7):409-14. https://doi.org/10.7326/0003-4819-155-7-201110040-00359
- Maisch B. Task Force on the diagnosis and management of pricardial diseases of the European Society of Cardiology. Eur Heart J. 2004;25(7):587-610. https://doi.org/10.1016/j.ehj.2004.02.002
- Imazio M, Brucato A, Cumetti D, et al. Corticosteroids for recurrent pericarditis: high versus low doses: a nonrandomized observation. Circulation. 2008;118(6):667-71. https://doi.org/10.1161/CIRCULATIONAHA.107.761064
- Picco P, Brisca G, Traverso F, et al. Successful treatment of idiopathic recurrent pericarditis in children with interleukin-1beta receptor antagonist (anakinra): an unrecognized autoinflammatory disease? Arthritis Rheum. 2009;60(1):264-8. https://doi.org/10.1002/art.24174
- Brucato A, Imazio M, Gattorno M, et al. Effect of Anakinra on Recurrent Pericarditis Among Patients With Colchicine Resistance and Corticosteroid Dependence: The AIRTRIP Randomized Clinical Trial. JAMA. 2016;316(18):1906-12. https://doi.org/10.1001/jama.2016.15826
- 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(6):1425-1431.e1421. https://doi.org/10.1016/j.jpeds.2014.01.065
Telif hakkı ve lisans
Telif hakkı © 2026 Yazar(lar). Açık erişimli bu makale, orijinal çalışmaya uygun şekilde atıfta bulunulması koşuluyla, herhangi bir ortamda veya formatta sınırsız kullanım, dağıtım ve çoğaltmaya izin veren Creative Commons Atıf Lisansı (CC BY) altında dağıtılmıştır.