Azathioprine in isolated recurrent pericarditis: A single centre experience

Vianello, Fabrizio; Cinetto, Francesco; Cavraro, Monica; Battisti, Anna; Castelli, Monica; Imbergamo, Silvia; Marcolongo, R

doi:10.1016/j.ijcard.2011.01.027

Cited by 112 publications

(72 citation statements)

References 14 publications

(6 reference statements)

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“…azatiopryna), dożylne preparaty immunoglobulin (IVIG) oraz antagoniści interleukiny 1 (IL-1) (np. anakinra) [20][21][22][23][28][29][30][31][32]. Jak udowodniono, u chorych z nawracającym opornym zapaleniem osierdzia istotną alternatywę dla farmakoterapii stanowi perikardiektomia [33].…”

Section: Co Nowego W Chorobach Osierdzia?unclassified

“…Pacjentom wymagającym długotrwałego leczenia bardzo dużymi dawkami kortykosteroidów (np. 15-25 mg prednizonu na dobę) lub u których nie uzyskano odpowiedzi na leczenie środkami przeciwzapalnymi podawano wiele innych preparatów, w tym azatioprynę [28], IVIG (preparat o działaniu immunomodulującym, ale też przeciwwirusowym) [29,30] oraz anakinrę, rekombinowany antagonista receptora IL-1b [31,32]. W literaturze nie ma jednak silnych dowodów na skuteczność tych metod (dodatkowa tab.…”

Section: Leczenieunclassified

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2015 ESC Guidelines for the diagnosis and management of pericardial diseases

Adler

Charron²,

Imazio³

et al. 2015

Kardiol Pol

173

293

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Section: Co Nowego W Chorobach Osierdzia?unclassified

Section: Leczenieunclassified

2015 ESC Guidelines for the diagnosis and management of pericardial diseases

Adler

Charron²,

Imazio³

et al. 2015

Kardiol Pol

173

293

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“…The experience with other immunomodulatory agents in refractory recurrent pericarditis is very limited, but studies involving a small number of patients demonstrate improvements after treatment with immunoglobulin, anti-tumor necrosis factor-α, antibody, methotrexate, azathioprine, anakinra, or interleukin-1β antagonists. 3,20,21 Although recurrent pericarditis can be very disabling, patients without an identified underlying cause seldom progress to serious subsequent complications (e.g. constrictive pericarditis).…”

Section: 14mentioning

confidence: 99%

Acute pericarditis

Tonini

Melo²,

Fernandes³

2015

Rev. Assoc. Med. Bras.

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Conflict of interest: noneAcute pericarditis is a common disease caused by inflammation of the pericardium, usually benign and self-limited and can occur as an isolated or as a manifestation of a systemic disease entity. Represents 5% of all causes of chest pain in the emergency room. The main etiology are viral infections, although it can also be secondary to systemic diseases and infections. The main complication of acute pericarditis is pericardial effusion, triggering a cardiac tamponade. The first line of treatment is the use of anti-inflammatory and or acetylsalicylic acid. Most patients have a good initial response to an NSAID associated to colchicine and became asymptomatic within a few days. This review article seeks to contemplate the main clinical findings and armed investigation to optimize the diagnosis of this important disease, as well as addressing their therapeutic management.Keywords: acute pericarditis, pericardial effusion, chest pain, colchicine. clinical definitionThe pericardium is a fibroelastic sac composed of two layers (visceral and parietal), separated by a virtual space called the pericardial cavity, which is filled with 15 to 50 mL of plasma ultrafiltrate in healthy subjects. Acute pericarditis is a common disease caused by inflammation of the pericardium, usually benign and selflimited, and may occur as an isolated entity or as a manifestation of a systemic disease.The real incidence and prevalence of pericarditis is difficult to quantify. Necropsy studies suggest a prevalence of approximately 1%. It affects mainly young males (aged between twenty and fifty years) without previous pathologies and represents 5% of all causes of chest pain in the emergency room. In developed countries, about 80-90% of cases are idiopathic, assuming that its main etiology is viral infection, although it can also be secondary to systemic diseases and infections.

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“…[44][45][46] Corticosteroids and immunosuppressive agents may be used in refractory cases. [47][48][49] Relapses may occur during reduction of drug doses or after discontinuation of treatment. These may arise due to insufficient dose or/and duration of NSAIDs, too rapid tapering of corticosteroids, real reactivation in autoimmune forms, or true reinfection.…”

Section: Irap Therapymentioning

confidence: 99%

“…48 In refractory cases, eg, those requiring unacceptably high chronic dosages of corticosteroids (higher than 15-20 mg/day) for symptom control, several immunosuppressive or immunomodulatory drugs have been employed, in particular azathioprine, cyclosporine, methotrexate, hydroxychloroquine, high dose intravenous immunoglobulins, and cyclophosphamide. 47,49 Azathioprine (at a dosage of 2-3 mg/kg/day) has been most often used. In general, less toxic and less expensive drugs are preferred, tailoring therapy to the individual patient as well as to the physician's preference.…”

Section: Irap Therapymentioning

confidence: 99%

Acute idiopathic pericarditis: current immunological theories

Caforio¹,

Marcolongo²,

Brucato³

et al. 2012

RRCC

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Idiopathic recurrent acute pericarditis (IRAP) is a rare disease of suspected immune-mediated pathogenesis. It represents a diagnosis of exclusion. It is necessary to rule out infectious and noninfectious causes of pericardial inflammation, including systemic autoimmune and immune-related disorders, eg, Sjögren's disease, systemic lupus erythematosus. Since pericarditis may precede diagnosis of these disorders, IRAP diagnosis is often made after a long follow-up. According to the two main pathogenetic theories IRAP may represent an organ-specific autoimmune disease or an autoinflammatory disease (AInfD). The main evidence for autoimmunity in IRAP is provided by the detection of serum antiheart and antiintercalateddisk autoantibodies, and the response to anti-inflammatory or immunosuppressive therapy. The findings of familial forms and of proinflammatory cytokines in the pericardial fluid in IRAP would be in keeping with both organ-specific autoimmune disease and AInfD. In fact, AInfD are genetic disorders characterized by primary dysfunction of the innate immune system, due to mutations of genes involved in the regulation of the inflammatory response, in the absence of antigen specific T cells or autoantibodies. In AInfD there are active disease phases with raised non-cardiac specific inflammatory markers, such as C-reactive protein, as well as symptom-free intervals with possible C-reactive protein normalization. A minority of IRAP patients (6%) carry a mutation in the TNFRSF1A gene, encoding the receptor for tumor necrosis factor-alfa. This suggests that some IRAP patients may have an atypical or subclinical form of AInfD. Thus, IRAP may represent a syndrome with distinct pathogenetic mechanisms in different patients' subsets.

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Azathioprine in isolated recurrent pericarditis: A single centre experience

Cited by 112 publications

References 14 publications

2015 ESC Guidelines for the diagnosis and management of pericardial diseases

2015 ESC Guidelines for the diagnosis and management of pericardial diseases

Acute pericarditis

Acute idiopathic pericarditis: current immunological theories

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