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Abstract Number: 1214

Resistant Or Recurrent Acute Pericarditis: A New Therapeutic Opportunity?

Claire Massardier1, Claire Dauphin2, Romain Eschalier2, Jean-René Lusson2 and Martin Soubrier3, 1cardiology, CHU CLERMONT-FERRAND, Clermont-ferrand, Colombia, 2cardiology, CHU CLERMONT-FERRAND, Clermont-ferrand, France, 3Rheumatology, CHU CLERMONT-FERRAND, Clermont-Ferrand, France

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Anakinra and cardiovascular disease

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Session Information

Title: Miscellaneous Rheumatic and Inflammatory Diseases I: Autoinflammatory Syndromes

Session Type: Abstract Submissions (ACR)

Background/Purpose: The treatment of recurrent pericarditis relies on aspirin and/or non-steroidal anti-inflammatory drugs, as well as colchicine. Corticosteroid therapy, which is offered in resistant forms, puts patients at risk of recurrence. Anakinra has shown itself to be effective in idiopathic recurrent pericarditis in childhood1, 2.

Methods: To report case studies of two patients who responded well to anakinra.

Results:

 Case 1: A 60-year old obese female with insulin-dependent diabetes and hypertension who had acute pericarditis with very high inflammatory markers (CRP 337) that recurred when her treatment with aspirin was tapered.

Investigations for aetiology were unremarkable. The patient presented clinical signs of constrictive pericarditis. The ultrasound scan showed circumferential pericardial effusion with compression of the right chambers. It was assessed as 1 liter on the chest CT scan. 

After four days of the standard treatment with aspirin and colchicine, which was unsuccessful, treatment with anakinra was initiated, chosen over corticosteroids due to the patient’s diabetes. The patient quickly showed a favourable response. At two months, the patient is asymptomatic and no longer has pericardial effusion or signs of inflammation.

Case 2: A 52-year old female with a 7-month history of persistent recurrent pericarditis in spite of receiving a long-term standard treatment of aspirin, followed by naproxen, then IV ketoprofen, all combined with colchicine.

 The clinical examination found an intermittent pericardial friction rub, echocardiography and CT found moderate pericardial effusion without compression, and inflammatory marker tests were negative (CRP<2.9 mg/l, ESR 2 mm).

 Initiation of anakinra led to rapid clinical improvement, which persisted at two months, with gradual reduction of the pericardial effusion.

Conclusion:  Anakinra could be a treatment for recurrent pericarditis or pericarditis with very high inflammatory markers that does not respond to the standard treatment and for which corticosteroid therapy is being considered.

 

  1. Scardapane A., et al., Pediatr Cardiol. 2012: DOI 10.1007/s00246-012-0532-0
  2. Picco P., et al., Arthritis & Rheumatism. 2009; 60(1):264–268

Disclosure:

C. Massardier,
None;

C. Dauphin,
None;

R. Eschalier,
None;

J. R. Lusson,
None;

M. Soubrier,
None.

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