Recurrent acute pericarditis in Takayasu arteritis

Melboucy‐Belkhir, Sara; Compain, Caroline; Sacré, Karim; Bussone, Guillaume; Chauveheid, Marie-Paule; Pasi, Nicoletta; Deschamps, Lydia; Mouthon, Luc; Papo, Thomas

doi:10.1016/j.ijcard.2012.09.106

Cited by 7 publications

(2 citation statements)

References 8 publications

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“…Takayasu arteritis is the prototypic large-vessel vasculitis (45,46), and is the third most frequent pediatric vasculitis (47). Takayasu arteritis might be associated with pericarditis at disease onset or in the case of very high disease activity (48).…”

Section: Vasculitismentioning

confidence: 99%

Recurrent pericarditis in children and adolescents

Imazio

Brucato

Pluymaekers

et al. 2016

Journal of Cardiovascular Medicine

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Section: Vasculitismentioning

confidence: 99%

Recurrent pericarditis in children and adolescents

Imazio

Brucato

Pluymaekers

et al. 2016

Journal of Cardiovascular Medicine

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“…After 6 months, she was asymptomatic, the prednisone had been tapered off, and repeat PET‐CT showed marked interval decrease in hypermetabolic activity of the PA with a maximum SUV of 4.3 ( H ). Isolated PA involvement and pericarditis are rare initial Takayasu arteritis presentations ( 1 , 2 ). Takayasu arteritis has been successfully treated with tocilizumab in case reports, leading to a small phase III trial showing a trend to improvement ( 3 ).…”

mentioning

confidence: 99%

Clinical Images: Takayasu arteritis presenting with isolated pulmonary artery involvement and pericarditis treated with bypass and tocilizumab

Dhamrah

Tassiulas

Ghaw

et al. 2021

ACR Open Rheumatology

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Clinical Images: Takayasu arteritis presenting with isolated pulmonary artery involvement and pericarditis treated with bypass and tocilizumab The patient, a previously healthy 23-year-old woman, presented with midsternal chest pain and dyspnea worsening over 2 weeks, with 6 months of fatigue, night sweats, and arthralgias. Physical examination found sinus tachycardia and a 4/6 left upper sternal border systolic murmur. The erythrocyte sedimentation rate was 91 mm/hour; the C-reactive protein level was 127 mg/L. Other bloodwork results and extensive serologic analysis were unremarkable. A transthoracic echocardiogram showed moderate pericardial effusion and concern for pulmonary hypertension. A pericardiocentesis resulted in transient symptomatic improvement. Right heart catheterization found bilateral pulmonary artery (PA) stenosis but normal PA pressures (20/15 mm Hg). Positron emission tomography-computed tomography (PET-CT) showed focal increased uptake of 18 F-fluorodeoxyglucose in the main PA to the carina, with a standard uptake value (SUV) of 11.6 (A). An endobronchial ultrasound was attempted with inadequate sampling. Surgical exploration found a hard mass effect on bilateral PA walls, tunnel-like narrowing of the right PA, and complete adherence of the PA to the aorta. The patient received a bypass from the right PA to the proximal main PA with immediate improvement in right ventricular and PA pressures. PA histopathology showed inflammatory infiltrate with small lymphoid cells on hematoxylin and eosin (H&E) staining (B). Immunohistochemical staining showed predominant T-cell infiltrate with robust CD3+ staining (C); lighter CD4+ (D), CD8+ (E), and CD20+ (F) staining; and negative IgG4 staining (G). Findings were consistent with vasculitis, and Takayasu arteritis was diagnosed. The patient received prednisone (40 mg/day) and tocilizumab (8 mg/kg monthly).After 6 months, she was asymptomatic, the prednisone had been tapered off, and repeat PET-CT showed marked interval decrease in hypermetabolic activity of the PA with a maximum SUV of 4.3 (H). Isolated PA involvement and pericarditis are rare initial Takayasu arteritis presentations (1,2). Takayasu arteritis has been successfully treated with tocilizumab in case reports, leading to a small phase III trial showing a trend to improvement (3).

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Novel Pharmacotherapies for Recurrent Pericarditis: Current Options in 2020

et al. 2020

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Recent advances have shown impressive results by anti-interleukin 1 (IL-1) agents in refractory idiopathic recurrent pericarditis. Purpose of ReviewWe critically discuss the current state of the art of therapy of relapsing pericarditis, with a focus on new pharmacological approaches and on specific clinical settings such as pregnancy, pediatric patients, and secondary forms of relapsing pericarditis. Recent FindingsAntagonism of the IL-1 is highly effective in idiopathic recurrent pericarditis with autoinflammatory features. Currently, available anti-IL-1 agents are anakinra and canakinumab. Rilonacept is another IL-1 antagonist, currently studied in the phase-3 clinical trial RHAPSODY. Available data suggest similar efficacy and safety profiles of these three agents, although only anakinra has been tested in randomized clinical trials. These agents have slightly different pharmacological properties, being canakinumab a specific IL-1ß antagonist while anakinra and rilonacept are unselective IL-1α and IL-1ß blockers. To date, there is no evidence that specificity against IL-1ß affects safety and efficacy in patients with relapsing pericarditis, although it has been proposed that unspecific blockage might be useful in severe disease. Summary Anakinra is the first anti-IL-1 agent with well-documented efficacy and safety in adult and pediatric patients with idiopathic relapsing pericarditis. Other anti-IL-1 agents are currently under study. Future research should clarify the optimal duration of therapy and tapering schedule of treatment with these agents. Moreover, biomarkers would be required to understand which patients will benefit from early administration of IL-1 blockers due to refractoriness to conventional therapy and which others will suffer from recurrences during the tapering of these agents. Lastly, future studies should focus on the subjects with the autoimmune or the pauci-inflammatory phenotype of idiopathic refractory pericarditis.

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Recurrent acute pericarditis in Takayasu arteritis

Cited by 7 publications

References 8 publications

Recurrent pericarditis in children and adolescents

Recurrent pericarditis in children and adolescents

Clinical Images: Takayasu arteritis presenting with isolated pulmonary artery involvement and pericarditis treated with bypass and tocilizumab

Novel Pharmacotherapies for Recurrent Pericarditis: Current Options in 2020

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